Provider Demographics
NPI:1831888924
Name:DE QUESADA DIAZ, AMERICA BEATRIZ
Entity type:Individual
Prefix:
First Name:AMERICA
Middle Name:BEATRIZ
Last Name:DE QUESADA DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 W 76TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5648
Mailing Address - Country:US
Mailing Address - Phone:786-614-3455
Mailing Address - Fax:
Practice Address - Street 1:2620 W 76TH ST APT 106
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5648
Practice Address - Country:US
Practice Address - Phone:786-614-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025919363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty