Provider Demographics
NPI:1033666052
Name:QUEZADA, LORENA (ASW, PPSC)
Entity type:Individual
Prefix:MISS
First Name:LORENA
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:ASW, PPSC
Other - Prefix:MISS
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:QUEZADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASW, PPSC
Mailing Address - Street 1:12623 AVENUE 416
Mailing Address - Street 2:
Mailing Address - City:OROSI
Mailing Address - State:CA
Mailing Address - Zip Code:93647-2017
Mailing Address - Country:US
Mailing Address - Phone:559-528-4763
Mailing Address - Fax:559-528-9319
Practice Address - Street 1:12623 AVENUE 416
Practice Address - Street 2:
Practice Address - City:OROSI
Practice Address - State:CA
Practice Address - Zip Code:93647-2017
Practice Address - Country:US
Practice Address - Phone:559-528-4763
Practice Address - Fax:559-528-9319
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1054211041S0200X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator