Healthcare Provider Details

I. General information

NPI: 1063316701
Provider Name (Legal Business Name): BRIAN JESUS QUESADA ELIZONDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 BELFORT RD STE 305
JACKSONVILLE FL
32216-8210
US

IV. Provider business mailing address

9735 CARBONDALE DR W
JACKSONVILLE FL
32208-1520
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-0046
  • Fax:
Mailing address:
  • Phone: 816-996-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number103824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: