Healthcare Provider Details

I. General information

NPI: 1225975899
Provider Name (Legal Business Name): KAYLA MARIE QUINTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 BROADWAY AVE
EL CENTRO CA
92243-2317
US

IV. Provider business mailing address

1256 BROADWAY AVE
EL CENTRO CA
92243-2317
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-5712
  • Fax: 760-337-5159
Mailing address:
  • Phone: 760-352-5712
  • Fax: 760-337-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN757226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: