1235107756 NPI number — MRS. SYLVIA TRISTAN QUEZADA MSW

Table of content: MRS. SYLVIA TRISTAN QUEZADA MSW (NPI 1235107756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235107756 NPI number — MRS. SYLVIA TRISTAN QUEZADA MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUEZADA
Provider First Name:
SYLVIA
Provider Middle Name:
TRISTAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIRTH
Provider Other First Name:
SYLVIA
Provider Other Middle Name:
T.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235107756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USAHCH
Provider Second Line Business Mailing Address:
CMR 470, BOX 4867
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09165
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
01149618188
Provider Business Mailing Address Fax Number:
8874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAHCH
Provider Second Line Business Practice Location Address:
CMR 470, BOX 4867
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09165
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
01149618188
Provider Business Practice Location Address Fax Number:
8874
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  S 05818 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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