Healthcare Provider Details

I. General information

NPI: 1528609971
Provider Name (Legal Business Name): MARTHA PATRICIA QUINTANA RN,BSN,PHN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 NEILSON ST STE 201
WATSONVILLE CA
95076-2485
US

IV. Provider business mailing address

50 SHADY OAKS DR
WATSONVILLE CA
95076-2531
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-6445
  • Fax: 831-722-2462
Mailing address:
  • Phone: 831-840-2136
  • Fax: 831-722-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number365693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: