Provider Demographics
NPI:1043516206
Name:OQUENDO, ZORAIDA A
Entity type:Individual
Prefix:MRS
First Name:ZORAIDA
Middle Name:A
Last Name:OQUENDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 EL NORTE PKWY SPC 218
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2256
Mailing Address - Country:US
Mailing Address - Phone:760-429-4083
Mailing Address - Fax:760-380-4042
Practice Address - Street 1:573 SOUTH LOOP 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-4042
Practice Address - Fax:760-380-4042
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178001659101YA0400X
MDLCA 327101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)