Individual
ANTONIO DE JESUS QUEZADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACSW
Contact information
Practice address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(323) 993-7629
Mailing address
501 W REDLANDS BLVD STE B, REDLANDS, CA 92373-4642
(909) 686-6233
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
130229
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01536011
MEDI-CAL
CA
Enumeration date
02/17/2022
Last updated
06/04/2025
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