Healthcare Provider Details

I. General information

NPI: 1093902496
Provider Name (Legal Business Name): JUAN MANUEL QUEVEDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 GATEWAY CENTER WAY STE 207
SAN DIEGO CA
92102-4544
US

IV. Provider business mailing address

9373 HAZARD WAY STE 200 STE 200
SAN DIEGO CA
92123-1226
US

V. Phone/Fax

Practice location:
  • Phone: 619-263-9729
  • Fax: 619-263-9730
Mailing address:
  • Phone: 858-810-8000
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA144881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: