Healthcare Provider Details

I. General information

NPI: 1275796898
Provider Name (Legal Business Name): MARIA DE LOS ANGELES QUINTERO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 NW 82ND AVE STE 304
DORAL FL
33166-6682
US

IV. Provider business mailing address

3650 NW 82ND AVE STE 304
DORAL FL
33166-6682
US

V. Phone/Fax

Practice location:
  • Phone: 305-406-9636
  • Fax: 305-406-1602
Mailing address:
  • Phone: 305-406-9636
  • Fax: 305-406-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number7448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: