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NPI Code Detail

MEDICARE: MICHALENE QUINTANA

MEDICARE: MICHALENE QUINTANA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-22-62857NM

General Provider Information

NPI Number : 1407476419
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHALENE QUINTANA
Provider Business Mailing Address
First Line : 2600 PALMILLA RD NW
Second Line :
City : LOS LUNAS
State : NM
Zip : 87031-4864
Country : US
Telephone Number : 505-295-2707
Fax Number :
Provider Business Practice Location Address
First Line : 2600 PALMILLA RD NW
Second Line :
City : LOS LUNAS
State : NM
Zip : 87031-4864
Country : US
Telephone Number : 505-295-2707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2020
Last Update Date : 01/13/2023

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Directions to “ MICHALENE QUINTANA ” Practice Location

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