Healthcare Provider Details

I. General information

NPI: 1174981773
Provider Name (Legal Business Name): CATALINA QUEZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11535 AVENUE 264
VISALIA CA
93277-9315
US

IV. Provider business mailing address

PO BOX 5091
VISALIA CA
93292
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-3984
  • Fax: 559-747-3642
Mailing address:
  • Phone: 559-747-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: