1699092783 NPI number — ABEL QUESADA, APC

Table of content: (NPI 1699092783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699092783 NPI number — ABEL QUESADA, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABEL QUESADA, APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
L.A. URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699092783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 E BROADWAY
Provider Second Line Business Mailing Address:
#251
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91205-1315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-676-5111
Provider Business Mailing Address Fax Number:
323-676-5112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4221 S ALAMEDA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90058-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-676-5111
Provider Business Practice Location Address Fax Number:
323-676-5112
Provider Enumeration Date:
04/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
QUESADA
Authorized Official First Name:
ABEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
323-676-5111

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  A100315 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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