Provider Demographics
NPI:1194543629
Name:QUEZADA GONZALEZ, ADRIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:QUEZADA GONZALEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 MIRAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2513
Mailing Address - Country:US
Mailing Address - Phone:805-844-4879
Mailing Address - Fax:
Practice Address - Street 1:1740 S VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6592
Practice Address - Country:US
Practice Address - Phone:805-644-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA899541835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy