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General NPI Number Information
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NPI Number | 1538876982
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Entity Type | Individual
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Provider Name | JOSE WILLIAM OQUENDO JR. MSW, M.DIV.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 1845 BUSINESS CENTER DR STE 106
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3447
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Country | US
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Telephone | 909-804-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 25852 IRIS AVE UNIT A
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City | MORENO VALLEY
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State | CA
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Zip | 92551-2943
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Country | US
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Telephone | 626-319-8127
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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