Provider Demographics
NPI:1720757396
Name:QUESADA GOMEZ, ARTURO ERNESTO
Entity type:Individual
Prefix:
First Name:ARTURO
Middle Name:ERNESTO
Last Name:QUESADA GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15846 75TH AVE # A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1026
Mailing Address - Country:US
Mailing Address - Phone:346-363-8416
Mailing Address - Fax:
Practice Address - Street 1:15846 75TH AVE # A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1026
Practice Address - Country:US
Practice Address - Phone:346-363-8416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY749186163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse