Healthcare Provider Details

I. General information

NPI: 1275074395
Provider Name (Legal Business Name): TOPACIO QUEZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33730 YUCAIPA BLVD # 1044
YUCAIPA CA
92399-2243
US

IV. Provider business mailing address

33730 YUCAIPA BLVD # 1044
YUCAIPA CA
92399-2243
US

V. Phone/Fax

Practice location:
  • Phone: 323-484-3179
  • Fax:
Mailing address:
  • Phone: 323-484-3179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number92251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: