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NPI Code Detail

MEDICARE: ROBERT LEO QUESADA

MEDICARE: ROBERT LEO QUESADA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1710029780
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT LEO QUESADA
Provider Business Mailing Address
First Line : 2180 VALLEY BLVD
Second Line :
City : POMONA
State : CA
Zip : 91768-3325
Country : US
Telephone Number : 909-865-2336
Fax Number : 909-865-1831
Provider Business Practice Location Address
First Line : 2180 VALLEY BLVD
Second Line :
City : POMONA
State : CA
Zip : 91768-3325
Country : US
Telephone Number : 900-865-2336
Fax Number : 909-865-1831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 09/29/2016

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Directions to “ ROBERT LEO QUESADA ” Practice Location

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