Healthcare Provider Details

I. General information

NPI: 1306133988
Provider Name (Legal Business Name): EDUARDO JAVIER QUINTERO-NAZARIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SEACREST BLVD STE 110
BOYNTON BEACH FL
33435-7960
US

IV. Provider business mailing address

2800 S SEACREST BLVD STE 110
BOYNTON BEACH FL
33435-7960
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-5220
  • Fax: 631-444-5225
Mailing address:
  • Phone: 561-226-6610
  • Fax: 561-226-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number289888
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number153144
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: