Provider Demographics
NPI:1285053348
Name:QUEZADA, CINDY P
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:P
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E THOUSAND OAKS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7762
Mailing Address - Country:US
Mailing Address - Phone:805-253-3433
Mailing Address - Fax:
Practice Address - Street 1:280 E THOUSAND OAKS BLVD STE D
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7762
Practice Address - Country:US
Practice Address - Phone:805-253-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA122369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56CCOtherASPIRA