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General NPI Number Information
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NPI Number | 1942177290
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Entity Type | Organization
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Legal Business Name | TOPAZ THERAPY
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 17192 CERES AVE
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City | FONTANA
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State | CA
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Zip | 92335
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Country | US
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Telephone | 323-484-3179
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Fax |
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Provider Business Mailing Address
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Address Line | 33730 YUCAIPA BLVD
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City | YUCAIPA
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State | CA
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Zip | 92399-2243
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Country | US
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Telephone | 323-484-3179
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | TOPACIO QUEZADA
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Credential |
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Telephone | 323-484-3179
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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 |
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