Individual
DR. JAIME A QUEJADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD,MS
Contact information
Practice address
1205 W VISTA WAY, VISTA, CA 92083-6227
(760) 941-5051
(888) 228-5701
Mailing address
BUMED OFFICE OF THE MEDICAL INSPECTOR GENERAL, 7700 ARLINGTON BLVD., STE 5134, FALLS CHURCH, VA 22042-5134
(202) 288-7813
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DDS35196
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33-0820906
TAX ID
CA
01
—
DC35196
LICENSE
CA
Enumeration date
09/25/2006
Last updated
10/19/2023
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