Healthcare Provider Details

I. General information

NPI: 1508798323
Provider Name (Legal Business Name): PAMELA PEREZ QUEZADA-GRUPO NAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA QUEZADA

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 RHODORA HEIGHTS RD
LAKE STEVENS WA
98258-9268
US

IV. Provider business mailing address

615 RHODORA HEIGHTS RD
LAKE STEVENS WA
98258-9268
US

V. Phone/Fax

Practice location:
  • Phone: 575-626-0775
  • Fax:
Mailing address:
  • Phone: 575-626-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number029781
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: