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General NPI Number Information
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NPI Number | 1487537247
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Entity Type | Organization
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Legal Business Name | SANDY QUEZADA
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 4740 N GRAND AVE
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City | COVINA
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State | CA
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Zip | 91724-2005
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Country | US
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Telephone | 626-859-2089
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Fax |
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Provider Business Mailing Address
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Address Line | 4740 N GRAND AVE
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City | COVINA
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State | CA
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Zip | 91724-2005
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Country | US
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Telephone | 626-859-2089
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Fax |
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | VASTHI CEDILLO
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Credential |
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Telephone | 626-859-2089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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