Healthcare Provider Details

I. General information

NPI: 1164139309
Provider Name (Legal Business Name): JAMES GUZMAN QUINTERO ASTR'S AOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES GUZMAN QUINTERO ASTR'S AOS

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 MCCULLOCH BLVD N STE F
LAKE HAVASU CITY AZ
86403-6811
US

IV. Provider business mailing address

2075 SANDWOOD DR STE 102
LAKE HAVASU CITY AZ
86403-3083
US

V. Phone/Fax

Practice location:
  • Phone: 928-230-3287
  • Fax:
Mailing address:
  • Phone: 928-230-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-18347
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: