Healthcare Provider Details

I. General information

NPI: 1689382376
Provider Name (Legal Business Name): CAITLIN QUESENBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 E 6TH ST
LONG BEACH CA
90802-1402
US

IV. Provider business mailing address

341 E 6TH ST
LONG BEACH CA
90802-1402
US

V. Phone/Fax

Practice location:
  • Phone: 562-435-7350
  • Fax:
Mailing address:
  • Phone: 562-435-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1484800922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: