Healthcare Provider Details

I. General information

NPI: 1083847206
Provider Name (Legal Business Name): NORMAN CUAUHTEMOC QUESADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 GARTH RD #119
BAYTOWN TX
77521-3167
US

IV. Provider business mailing address

4201 GARTH RD #119
HOUSTON TX
37212
US

V. Phone/Fax

Practice location:
  • Phone: 281-428-4101
  • Fax:
Mailing address:
  • Phone: 281-428-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD51769
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number51769
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: