Healthcare Provider Details

I. General information

NPI: 1285802769
Provider Name (Legal Business Name): PETER S QUINTERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E 19TH AVE STE 468 468
DENVER CO
80218-1242
US

IV. Provider business mailing address

1721 E 19TH AVE STE 468
DENVER CO
80218-1242
US

V. Phone/Fax

Practice location:
  • Phone: 303-863-0501
  • Fax: 303-863-0497
Mailing address:
  • Phone: 303-863-0501
  • Fax: 303-863-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15957
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: