Healthcare Provider Details

I. General information

NPI: 1730872565
Provider Name (Legal Business Name): ESMERALDA QUEZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 CANYON CREST DR STE 204
RIVERSIDE CA
92507-6035
US

IV. Provider business mailing address

PO BOX 70360
RIVERSIDE CA
92513-0360
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-1488
  • Fax: 951-682-1485
Mailing address:
  • Phone: 951-425-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW122626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: