Healthcare Provider Details

I. General information

NPI: 1487537247
Provider Name (Legal Business Name): SANDY QUEZADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 N GRAND AVE
COVINA CA
91724-2005
US

IV. Provider business mailing address

4740 N GRAND AVE
COVINA CA
91724-2005
US

V. Phone/Fax

Practice location:
  • Phone: 626-859-2089
  • Fax:
Mailing address:
  • Phone: 626-859-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VASTHI CEDILLO
Title or Position: BILLING COORDINATOR
Credential:
Phone: 626-859-2089