Healthcare Provider Details

I. General information

NPI: 1235066101
Provider Name (Legal Business Name): AMAYA ANGELIQUE QUEZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 BERNAL RD
SAN JOSE CA
95119-1809
US

IV. Provider business mailing address

227 MARTINVALE LN
SAN JOSE CA
95119-1872
US

V. Phone/Fax

Practice location:
  • Phone: 408-638-4744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: