Healthcare Provider Details

I. General information

NPI: 1487349205
Provider Name (Legal Business Name): MARIA GABRIELA QUINTANA MARINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SW 2ND TER
CAPE CORAL FL
33991-1958
US

IV. Provider business mailing address

305 SW 2ND TER
CAPE CORAL FL
33991-1958
US

V. Phone/Fax

Practice location:
  • Phone: 844-342-7935
  • Fax:
Mailing address:
  • Phone: 844-342-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME181107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: