Provider Demographics
NPI:1699561936
Name:QUEZADA, MAYRA ELIZABETH (APCC, AMFT)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:ELIZABETH
Last Name:QUEZADA
Suffix:
Gender:
Credentials:APCC, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-0064
Mailing Address - Country:US
Mailing Address - Phone:760-419-3928
Mailing Address - Fax:
Practice Address - Street 1:3548 SEAGATE WAY STE 150
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2676
Practice Address - Country:US
Practice Address - Phone:619-289-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT153788106H00000X
CAAPCC18914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist