Basic Information
| Provider Information | |||||||||
| NPI: | 1538876982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OQUENDO | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MSW, M.DIV. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25852 IRIS AVE UNIT A | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925512943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263198127 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1845 BUSINESS CENTER DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098048877 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2022 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.