Provider Demographics
NPI:1881139178
Name:RACQUEL S QUEMA MD INC
Entity type:Organization
Organization Name:RACQUEL S QUEMA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:QUEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-900-2301
Mailing Address - Street 1:421 E ANGELENO AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2286
Mailing Address - Country:US
Mailing Address - Phone:818-900-2301
Mailing Address - Fax:818-009-2471
Practice Address - Street 1:421 E ANGELENO AVE STE 105
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2286
Practice Address - Country:US
Practice Address - Phone:818-900-2301
Practice Address - Fax:818-900-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033369467Medicare UPIN