Provider Demographics
NPI:1902691959
Name:QUESADA-LOPEZ, YANZA (CHW)
Entity type:Individual
Prefix:
First Name:YANZA
Middle Name:
Last Name:QUESADA-LOPEZ
Suffix:
Gender:
Credentials:CHW
Other - Prefix:
Other - First Name:YANZA
Other - Middle Name:MARIA
Other - Last Name:QUESADA-LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW
Mailing Address - Street 1:4401 MONTGOMERY BLVD NE APT J94
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1208
Mailing Address - Country:US
Mailing Address - Phone:505-730-6976
Mailing Address - Fax:
Practice Address - Street 1:7704 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6755
Practice Address - Country:US
Practice Address - Phone:505-924-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMG1735172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker