Basic Information
| Provider Information | |||||||||
| NPI: | 1235214263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUESADA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | LOURDES | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 D ST | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949013707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155171309 | ||||||||
| FaxNumber: | 4154915750 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 D ST | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949013707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155171309 | ||||||||
| FaxNumber: | 4154915750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 04/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC40318 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.