MEDICARE: QUEST HEALTH MANAGEMENT, PSYCHOLOGICAL CORPORATION

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1750023487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST HEALTH MANAGEMENT, PSYCHOLOGICAL CORPORATION

Provider Business Mailing Address
First Line	:	4110 EDISON AVE STE 206A
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-8417
Country	:	US
Telephone Number	:	951-454-5577
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 EDISON AVE STE 206A
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-8417
Country	:	US
Telephone Number	:	951-454-5577
Fax Number	:

Authorized Official
Title or Position	:	CEO/MANAGING DIRECTOR
Name	:	DR. TSEDAY ABERRA
Credential	:	PSY.D.
Telephone Number	:	951-454-5577

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	04/12/2022

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