Healthcare Provider Details

I. General information

NPI: 1871418038
Provider Name (Legal Business Name): AUGUSTINE QUEJADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 E WILLOW ST
SIGNAL HILL CA
90755-2309
US

IV. Provider business mailing address

2234 CARFAX AVE
LONG BEACH CA
90815-2204
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-2225
  • Fax:
Mailing address:
  • Phone: 707-246-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: