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General NPI Number Information
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NPI Number | 1306947429
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Entity Type | Individual
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Provider Name | JAIME A QUEJADA DMD,MS
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 1205 W VISTA WAY
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City | VISTA
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State | CA
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Zip | 92083-6227
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Country | US
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Telephone | 760-941-5051
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Fax | 888-228-5701
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Provider Business Mailing Address
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Address Line | BUMED OFFICE OF THE MEDICAL INSPECTOR GENERAL 7700 ARLINGTON BLVD., STE 5134
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City | FALLS CHURCH
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State | VA
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Zip | 22042-5134
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Country | US
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Telephone | 202-288-7813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DDS35196
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License Number State | CA
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