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NPI Code Detail

MEDICARE: MRS. CRISTINA MARIE BOSTANIAN-QUEZADA LCSW

MEDICARE: MRS. CRISTINA MARIE BOSTANIAN-QUEZADA LCSW
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
11041C0700XClinical Social Worker112572CA

General Provider Information

NPI Number : 1255621645
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRISTINA MARIE BOSTANIAN-QUEZADA LCSW
Provider Business Mailing Address
First Line : 990 VILLA ST
Second Line :
City : MOUNTAIN VIEW
State : CA
Zip : 94041-1236
Country : US
Telephone Number : 818-468-6815
Fax Number :
Provider Business Practice Location Address
First Line : 990 VILLA ST
Second Line :
City : MOUNTAIN VIEW
State : CA
Zip : 94041-1236
Country : US
Telephone Number : 818-468-6815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2011
Last Update Date : 08/12/2024

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