MEDICARE: DR. CAROLINA QUEZADA MD

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	207R00000X	Internal Medicine Physician	A111051	CA
2	208000000X	Pediatrics Physician	A111051	CA

General Provider Information

NPI Number	:	1649502022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINA QUEZADA MD

Provider Business Mailing Address
First Line	:	305 EAST CENTER AVE.
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-6331
Country	:	US
Telephone Number	:	559-737-4700
Fax Number	:	559-737-4782

Provider Business Practice Location Address
First Line	:	201 EAST LAKEVIEW AVE.
Second Line	:
City	:	WOODLAKE
State	:	CA
Zip	:	93286-1422
Country	:	US
Telephone Number	:	559-564-0100
Fax Number	:	559-564-2285

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

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	07/30/2013

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