1639474703 NPI number — MR. JOSEPH LEE QUEZADA MSW

Table of content: MR. JOSEPH LEE QUEZADA MSW (NPI 1639474703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639474703 NPI number — MR. JOSEPH LEE QUEZADA MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUEZADA
Provider First Name:
JOSEPH
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUEZADA
Provider Other First Name:
JOSEPH
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639474703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1218 GRIEGOS RD NW, 87107
Provider Second Line Business Mailing Address:
HOGARES INC
Provider Business Mailing Address City Name:
ALBUQURQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-274-9796
Provider Business Mailing Address Fax Number:
505-891-3217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1218 GRIEGOS RD NW
Provider Second Line Business Practice Location Address:
1218 GRIEGOS RD NW
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87107-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-274-9796
Provider Business Practice Location Address Fax Number:
505-891-3217
Provider Enumeration Date:
01/20/2011

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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