MEDICARE: DAWN DELAINA QUIJADA

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	171400000X	Health & Wellness Coach
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1710734611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN DELAINA QUIJADA

Provider Business Mailing Address
First Line	:	4755 INGRAHAM ST APT 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3127
Country	:	US
Telephone Number	:	858-226-5545
Fax Number	:

Provider Business Practice Location Address
First Line	:	4755 INGRAHAM ST APT 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3127
Country	:	US
Telephone Number	:	858-226-5545
Fax Number	:

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

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	04/30/2024

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