Individual provider Active NPI

Fernando Quezada, PA-C

  • Physician Assistant
  • Temecula, CA
National Provider Identifier
1851411797
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA16181 Issued in CA
Practice address
31795 Rancho California Road Suite #B-700
Temecula, CA 92591-2993
Phone
(760) 291-6700
Fax
(951) 294-9039
NPI assigned
Mar 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA16181 CA Primary

Addresses

Primary practice location

31795 Rancho California Road Suite #B-700
Temecula, CA 92591-2993

Mailing address

225 East Second Avenue
Escondido, CA 92025-4249
Phone (760) 291-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041110000704 CA Practitioner - Physician Assistant 0042273021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Graybill Medical Group IncGroup PAC ID 9335050517, 103 clinicians

Practice addresses (Care Compare)

25405 Hancock Ave
Murrieta, CA 92562-5978
Phone (760) 291-6700

31795 Rancho California Rd
Suite B 700
Temecula, CA 92591-2993
Phone (760) 291-6700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
16181CAMDMental Health Counselor
PA16181CAMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1851411797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 EAST SECOND AVENUE",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920254249",
            "telephone_number": "760-291-6700",
            "fax_number": "760-737-7324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31795 RANCHO CALIFORNIA ROAD SUITE #B-700",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925912993",
            "telephone_number": "760-291-6700",
            "fax_number": "951-294-9039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEZADA",
        "first_name": "FERNANDO",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-31",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

Verify at the official NPI Registry.