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NPI Code Detail

MEDICARE: MRS. THAO T. QUEVEDO PA-C

MEDICARE: MRS. THAO T. QUEVEDO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA01763TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28N4446OTHERTXBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518967504
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THAO T. QUEVEDO PA-C
Provider Business Mailing Address
First Line : 5702 LAVON DR
Second Line :
City : GARLAND
State : TX
Zip : 75040-3126
Country : US
Telephone Number : 866-389-2727
Fax Number : 972-495-0327
Provider Business Practice Location Address
First Line : 5702 LAVON DR
Second Line :
City : GARLAND
State : TX
Zip : 75040-3126
Country : US
Telephone Number : 972-495-5595
Fax Number : 972-675-5806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2005
Last Update Date : 01/06/2026

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