Healthcare Provider Details

I. General information

NPI: 1841772068
Provider Name (Legal Business Name): DAVID QUESADA TRIGONIS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12427 HIGHWAY 231
YOUNGSTOWN FL
32466-2562
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 850-753-3246
  • Fax:
Mailing address:
  • Phone: 850-747-5599
  • Fax: 850-872-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW15632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: