Provider Demographics
NPI:1902667306
Name:QUEZADA, JULIE VIANEY
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:VIANEY
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 1:6501 VAN NUYS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1425
Mailing Address - Country:US
Mailing Address - Phone:818-989-7475
Mailing Address - Fax:
Practice Address - Street 1:6501 VAN NUYS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1425
Practice Address - Country:US
Practice Address - Phone:818-989-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner