Provider Demographics
NPI:1750161543
Name:QUEZADA, ESTEBAN ALBERTO (RPH)
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:ALBERTO
Last Name:QUEZADA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12005 BRAVEHEART AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0371
Mailing Address - Country:US
Mailing Address - Phone:915-319-8510
Mailing Address - Fax:
Practice Address - Street 1:1210 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7629
Practice Address - Country:US
Practice Address - Phone:915-591-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist