MEDICARE: JAVIER TENA QUESADA D.O.

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	207Q00000X	Family Medicine Physician	20A7433	CA

General Provider Information

NPI Number	:	1215929880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER TENA QUESADA D.O.

Provider Business Mailing Address
First Line	:	2600 REDONDO AVE
Second Line	:	SUITE 400
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2329
Country	:	US
Telephone Number	:	562-997-7888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 REDONDO AVE
Second Line	:	SUITE 400
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2329
Country	:	US
Telephone Number	:	562-997-7888
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	02/25/2015

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