Provider Demographics
NPI:1578123048
Name:QUIJADA, FERNANDA
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:QUIJADA
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 1:1849 N KOLB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4929
Mailing Address - Country:US
Mailing Address - Phone:520-391-9401
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1849 N KOLB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4929
Practice Address - Country:US
Practice Address - Phone:520-391-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2024-09-03
Deactivation Date:2024-08-13
Deactivation Code:
Reactivation Date:2024-09-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician