Basic Information
| Provider Information | |||||||||
| NPI: | 1104257278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIJADA | ||||||||
| FirstName: | LIANA | ||||||||
| MiddleName: | DESIREE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1502 W WEST COVINA PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269604844 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1502 W WEST COVINA PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917902703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269604844 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2013 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106H00000X | IMF101652 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 121648 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.