Provider Demographics
NPI:1871963017
Name:QUEZADA, ORALIA
Entity type:Individual
Prefix:
First Name:ORALIA
Middle Name:
Last Name:QUEZADA
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:PO BOX 1063
Mailing Address - Street 2:103 LIVINGSTON LOOP, BLDG B, SUITE 4
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-1063
Mailing Address - Country:US
Mailing Address - Phone:575-332-4271
Mailing Address - Fax:866-232-9241
Practice Address - Street 1:103 LIVINGSTON LOOP, BLDG B, SUITE 4
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-1063
Practice Address - Country:US
Practice Address - Phone:575-332-4271
Practice Address - Fax:866-232-9241
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program