Healthcare Provider Details

I. General information

NPI: 1588570816
Provider Name (Legal Business Name): CARLOS QUINTERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 NW 114TH AVE
DORAL FL
33178-4576
US

IV. Provider business mailing address

6420 NW 114TH AVE
DORAL FL
33178-4576
US

V. Phone/Fax

Practice location:
  • Phone: 305-733-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11050148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: