Healthcare Provider Details

I. General information

NPI: 1700795515
Provider Name (Legal Business Name): CRYSTAL QUEZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N SAN DIMAS AVE STE 219
SAN DIMAS CA
91773-2664
US

IV. Provider business mailing address

1927 JENNIFER PL
WEST COVINA CA
91792-1031
US

V. Phone/Fax

Practice location:
  • Phone: 909-519-8912
  • Fax:
Mailing address:
  • Phone: 626-824-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: