Basic Information
| Provider Information | |||||||||
| NPI: | 1811284656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUEZADA | ||||||||
| FirstName: | ESTHER | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2738 S DEL NORTE AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917617007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514154393 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2738 S DEL NORTE AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917617007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514154393 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2011 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 09/05/2018 | ||||||||
| NPIReactivationDate: | 09/25/2018 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 27011 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.