Provider Demographics
NPI:1366736829
Name:QUEZADA, ROSA MARIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10631 LINDLEY AVE
Mailing Address - Street 2:APT. #225
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3205
Mailing Address - Country:US
Mailing Address - Phone:818-389-0322
Mailing Address - Fax:
Practice Address - Street 1:821 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4735
Practice Address - Country:US
Practice Address - Phone:323-726-8080
Practice Address - Fax:323-726-8081
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist