Basic Information
| Provider Information | |||||||||
| NPI: | 1972261014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMEZQUITA | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | N/A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3491 KURTZ ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921104430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193325830 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1576 WOODLARK CT | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919115321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153550589 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2021 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.