Provider Demographics
NPI:1780451492
Name:QUEZADA, CRAIG DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:DAVID
Last Name:QUEZADA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 SAN DOMINGO ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5560
Mailing Address - Country:US
Mailing Address - Phone:757-750-5458
Mailing Address - Fax:
Practice Address - Street 1:2521 SAN DOMINGO ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5560
Practice Address - Country:US
Practice Address - Phone:757-750-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118229363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical