Provider Demographics
NPI:1932982394
Name:QUEZADA, ADRIANA MELISA
Entity Type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:MELISA
Last Name:QUEZADA
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 1:1305 E PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3529
Mailing Address - Country:US
Mailing Address - Phone:580-478-8062
Mailing Address - Fax:
Practice Address - Street 1:729 OVERLAND TRL
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-6304
Practice Address - Country:US
Practice Address - Phone:580-540-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician