Provider Demographics
NPI:1851411797
Name:QUEZADA, FERNANDO (PA-C)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 EAST SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4249
Mailing Address - Country:US
Mailing Address - Phone:760-291-6700
Mailing Address - Fax:760-737-7324
Practice Address - Street 1:31795 RANCHO CALIFORNIA ROAD SUITE #B-700
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-2993
Practice Address - Country:US
Practice Address - Phone:760-291-6700
Practice Address - Fax:951-294-9039
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant