Provider Demographics
NPI:1538876982
Name:OQUENDO, JOSE WILLIAM JR (MSW, MDIV)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:WILLIAM
Last Name:OQUENDO
Suffix:JR
Gender:M
Credentials:MSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25852 IRIS AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-2943
Mailing Address - Country:US
Mailing Address - Phone:626-319-8127
Mailing Address - Fax:
Practice Address - Street 1:1845 BUSINESS CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3447
Practice Address - Country:US
Practice Address - Phone:909-804-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health