Healthcare Provider Details

I. General information

NPI: 1619217528
Provider Name (Legal Business Name): ALICIA QUESADA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8570 SW 27TH LN
MIAMI FL
33155-2349
US

IV. Provider business mailing address

8570 SW 27TH LN
MIAMI FL
33155-2349
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-4799
  • Fax:
Mailing address:
  • Phone: 786-663-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH15942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9288870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: