MEDICARE: RACHEL QUEZADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224900000X	Mastectomy Fitter	C49774	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C49774	OTHER	CA	BOC

General Provider Information

NPI Number	:	1053756528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL QUEZADA

Provider Business Mailing Address
First Line	:	2624 F ST
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-1816
Country	:	US
Telephone Number	:	661-323-5944
Fax Number	:	661-323-2820

Provider Business Practice Location Address
First Line	:	2624 F ST
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-1816
Country	:	US
Telephone Number	:	661-323-5944
Fax Number	:	661-323-2820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	05/09/2013

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Directions to “ RACHEL QUEZADA ” Practice Location

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