Provider Demographics
NPI:1316725005
Name:QUESADA JIMENEZ, ROGER ANDRES (CSA)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:ANDRES
Last Name:QUESADA JIMENEZ
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 E TOUHY AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2748
Mailing Address - Country:US
Mailing Address - Phone:883-872-4477
Mailing Address - Fax:
Practice Address - Street 1:999 E TOUHY AVE STE 450
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2748
Practice Address - Country:US
Practice Address - Phone:883-872-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5409246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant