Provider Demographics
NPI:1194882860
Name:JOHNSON-QUIJADA, SANA L (MD)
Entity type:Individual
Prefix:
First Name:SANA
Middle Name:L
Last Name:JOHNSON-QUIJADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27475 YNEZ RD
Mailing Address - Street 2:#313
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4612
Mailing Address - Country:US
Mailing Address - Phone:951-514-1234
Mailing Address - Fax:951-894-6577
Practice Address - Street 1:32605 TEMECULA PKWY STE 220
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6840
Practice Address - Country:US
Practice Address - Phone:951-514-1234
Practice Address - Fax:888-313-3358
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA702702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH32806Medicare UPIN