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General NPI Number Information
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NPI Number | 1790241503
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Entity Type | Individual
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Provider Name | ADAM BALDUEZA QUEZON PTA
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Gender | Male
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Dates
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Enumeration Date | 02/17/2019
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Last Update Date | 02/17/2019
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Provider Practice Location Address
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Address Line | 110 41ST ST
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City | OAKLAND
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State | CA
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Zip | 94611-5250
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Country | US
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Telephone | 510-596-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 1921 26TH AVE APT 5
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City | OAKLAND
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State | CA
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Zip | 94601-1739
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Country | US
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Telephone | 805-415-4635
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA49079
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License Number State | CA
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