Healthcare Provider Details

I. General information

NPI: 1699561936
Provider Name (Legal Business Name): MAYRA ELIZABETH QUEZADA APCC, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3548 SEAGATE WAY STE 150
OCEANSIDE CA
92056-2676
US

IV. Provider business mailing address

PO BOX 64
BONSALL CA
92003-0064
US

V. Phone/Fax

Practice location:
  • Phone: 619-289-7322
  • Fax:
Mailing address:
  • Phone: 760-419-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT153788
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC18914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: