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NPI Code Detail

MEDICARE: MR. DAVID QUESADA TRIGONIS LCSW

MEDICARE: MR. DAVID QUESADA TRIGONIS LCSW
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
11041C0700XClinical Social WorkerSW15632FL

General Provider Information

NPI Number : 1841772068
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID QUESADA TRIGONIS LCSW
Provider Business Mailing Address
First Line : 403 E 11TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32401-3409
Country : US
Telephone Number : 850-747-5599
Fax Number : 850-872-4131
Provider Business Practice Location Address
First Line : 12427 HIGHWAY 231
Second Line :
City : YOUNGSTOWN
State : FL
Zip : 32466-2562
Country : US
Telephone Number : 850-753-3246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2018
Last Update Date : 09/04/2018

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