1639351992 NPI number — MRS. MARIA DE JESUS MCQUEARY OTR/L

Table of content: MRS. MARIA DE JESUS MCQUEARY OTR/L (NPI 1639351992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639351992 NPI number — MRS. MARIA DE JESUS MCQUEARY OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCQUEARY
Provider First Name:
MARIA
Provider Middle Name:
DE JESUS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ
Provider Other First Name:
MARIA
Provider Other Middle Name:
DE JESUS
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639351992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
473 MARA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93004-1506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-647-8914
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 SANTA ROSA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93012-7101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-388-8086
Provider Business Practice Location Address Fax Number:
805-388-8450
Provider Enumeration Date:
11/28/2007

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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