Provider Demographics
NPI:1710734611
Name:QUIJADA, DAWN DELAINA
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DELAINA
Last Name:QUIJADA
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 1:4755 INGRAHAM ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3127
Mailing Address - Country:US
Mailing Address - Phone:858-226-5545
Mailing Address - Fax:
Practice Address - Street 1:4755 INGRAHAM ST APT 6
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3127
Practice Address - Country:US
Practice Address - Phone:858-226-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach