Healthcare Provider Details

I. General information

NPI: 1134403454
Provider Name (Legal Business Name): MONICA M QUINTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 W 36TH STREET SUITE 9
DAVIE FL
33328
US

IV. Provider business mailing address

8001 W 36TH STREET SUITE 9
DAVIE FL
33328
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-7790
  • Fax: 954-577-7780
Mailing address:
  • Phone: 954-577-7790
  • Fax: 954-577-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: