Healthcare Provider Details

I. General information

NPI: 1578198065
Provider Name (Legal Business Name): SAMANTHA QUESADA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date: 06/20/2023
Reactivation Date: 09/24/2024

III. Provider practice location address

3100 TELEGRAPH AVE
OAKLAND CA
94609-3239
US

IV. Provider business mailing address

3801 MIRANDA AVE
PALO ALTO CA
94304-1290
US

V. Phone/Fax

Practice location:
  • Phone: 800-607-6377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL7100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: