Healthcare Provider Details

I. General information

NPI: 1639351992
Provider Name (Legal Business Name): MARIA DE JESUS MCQUEARY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA DE JESUS HERNANDEZ OTR/L

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SANTA ROSA RD
CAMARILLO CA
93012-7101
US

IV. Provider business mailing address

473 MARA AVE
VENTURA CA
93004-1506
US

V. Phone/Fax

Practice location:
  • Phone: 805-388-8086
  • Fax: 805-388-8450
Mailing address:
  • Phone: 805-647-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: