Healthcare Provider Details

I. General information

NPI: 1710734611
Provider Name (Legal Business Name): DAWN DELAINA QUIJADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 INGRAHAM ST APT 6
SAN DIEGO CA
92109-3127
US

IV. Provider business mailing address

4755 INGRAHAM ST APT 6
SAN DIEGO CA
92109-3127
US

V. Phone/Fax

Practice location:
  • Phone: 858-226-5545
  • Fax:
Mailing address:
  • Phone: 858-226-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: