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NPI Code Detail

MEDICARE: ANSELMO QUEZADA MS

MEDICARE: ANSELMO QUEZADA MS
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
1101YM0800XMental Health CounselorRC00054017WA

General Provider Information

NPI Number : 1750325270
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANSELMO QUEZADA MS
Provider Business Mailing Address
First Line : PO BOX 959
Second Line :
City : YAKIMA
State : WA
Zip : 98907-0959
Country : US
Telephone Number : 509-575-8084
Fax Number :
Provider Business Practice Location Address
First Line : 216 W 10TH AVE
Second Line :
City : KENNEWICK
State : WA
Zip : 99336-6300
Country : US
Telephone Number : 509-870-9150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 06/09/2026

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Directions to “ ANSELMO QUEZADA MS” Practice Location

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