Healthcare Provider Details

I. General information

NPI: 1164038022
Provider Name (Legal Business Name): CHRISTINE ANTOINETTE QUIJADA RN, PHN,NP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE ANTOINETTE VERGARA RN, NP, PMHNP

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 E 44TH PKWY
YUMA AZ
85365-0120
US

IV. Provider business mailing address

5675 E 44TH PKWY
YUMA AZ
85365-0120
US

V. Phone/Fax

Practice location:
  • Phone: 714-461-8379
  • Fax:
Mailing address:
  • Phone: 714-461-8379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95189049
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332598
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number332598
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: