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NPI Code Detail

MEDICARE: NELSON VICENTE QUEZADA JR. MD

MEDICARE: NELSON VICENTE QUEZADA JR. 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
1207L00000XAnesthesiology PhysicianA190752CA

General Provider Information

NPI Number : 1710515762
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELSON VICENTE QUEZADA JR. MD
Provider Business Mailing Address
First Line : PO BOX 31309
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-0309
Country : US
Telephone Number : 626-574-3540
Fax Number :
Provider Business Practice Location Address
First Line : 300 W HUNTINGTON DR
Second Line :
City : ARCADIA
State : CA
Zip : 91007-3402
Country : US
Telephone Number : 626-574-3540
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2020
Last Update Date : 12/12/2025

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