Provider Demographics
NPI:1699092783
Name:ABEL QUESADA, APC
Entity type:Organization
Organization Name:ABEL QUESADA, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-676-5111
Mailing Address - Street 1:1125 E BROADWAY
Mailing Address - Street 2:#251
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1315
Mailing Address - Country:US
Mailing Address - Phone:323-676-5111
Mailing Address - Fax:323-676-5112
Practice Address - Street 1:4221 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CA
Practice Address - Zip Code:90058-1601
Practice Address - Country:US
Practice Address - Phone:323-676-5111
Practice Address - Fax:323-676-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100315208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty