Basic Information
Provider Information
NPI: 1003018086
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: QUESADA
FirstName: MARIO
MiddleName: JOSEPH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1203E ALTON GLOOR BLVD
Address2:  
City: BROWNSVILLE
State: TX
PostalCode: 785263831
CountryCode: US
TelephoneNumber: 9565442663
FaxNumber: 9565422366
Practice Location
Address1: 1201 E ALTON GLOOR BLVD
Address2: SUITE B
City: BROWNSVILLE
State: TX
PostalCode: 785263831
CountryCode: US
TelephoneNumber: 9565442663
FaxNumber: 9565422366
Other Information
ProviderEnumerationDate: 06/01/2007
LastUpdateDate: 10/07/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XS0114XQ1711TXY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
207XS0114X13888NVN Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
207XP3100XMD200497LAN Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery

ID Information
IDTypeStateIssuerDescription
123771005LA MEDICAID


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