Healthcare Provider Details

I. General information

NPI: 1902584154
Provider Name (Legal Business Name): STEPHANIE BAXTER QUIJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 3RD AVE
CHULA VISTA CA
91911-3131
US

IV. Provider business mailing address

1465 30TH ST
SAN DIEGO CA
92154-3497
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-4661
  • Fax:
Mailing address:
  • Phone: 619-428-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC21256
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC21256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: