Provider Demographics
NPI:1578362307
Name:QUESADA, BLAIN GILBERT
Entity type:Individual
Prefix:MR
First Name:BLAIN
Middle Name:GILBERT
Last Name:QUESADA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4384 SAINT PAUL PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2437
Mailing Address - Country:US
Mailing Address - Phone:909-670-3170
Mailing Address - Fax:
Practice Address - Street 1:1455 W PARK AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8178
Practice Address - Country:US
Practice Address - Phone:909-793-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist