Healthcare Provider Details

I. General information

NPI: 1063335453
Provider Name (Legal Business Name): MAURICIO ANTONIO QUIJADA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 28TH AVE
SAN FRANCISCO CA
94116-2912
US

IV. Provider business mailing address

683 VIENNA ST
SAN FRANCISCO CA
94112-3556
US

V. Phone/Fax

Practice location:
  • Phone: 415-681-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: