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NPI Code Detail

MEDICARE: MATIAS MIGUEL QUINTANILLA MSN APRN FNP-BC

MEDICARE: MATIAS MIGUEL QUINTANILLA MSN APRN FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician11475617-4408UT
2363LF0000XFamily Nurse Practitioner841346NV
3207Q00000XFamily Medicine Physician11475617-3102UT
4363LF0000XFamily Nurse Practitioner11475617-4405UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2841346OTHERNVSTATE LICENSE

General Provider Information

NPI Number : 1306534458
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATIAS MIGUEL QUINTANILLA MSN APRN FNP-BC
Provider Business Mailing Address
First Line : 6355 S BUFFALO DR FL 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2133
Country : US
Telephone Number : 702-216-3346
Fax Number :
Provider Business Practice Location Address
First Line : 786 W PIONEER BLVD STE A
Second Line :
City : MESQUITE
State : NV
Zip : 89027-8862
Country : US
Telephone Number : 702-345-5000
Fax Number : 702-345-2000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2023
Last Update Date : 11/02/2025

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Directions to “ MATIAS MIGUEL QUINTANILLA MSN APRN FNP-BC” Practice Location

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