Healthcare Provider Details

I. General information

NPI: 1427515618
Provider Name (Legal Business Name): LUPITA QUEZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 07/03/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E. CESAR CHAVEZ AVE
FRESNO CA
93706-3642
US

IV. Provider business mailing address

142 E. CESAR CHAVEZ AVE
FRESNO CA
93706
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9126
  • Fax:
Mailing address:
  • Phone: 559-903-8651
  • Fax: 844-587-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: