Healthcare Provider Details

I. General information

NPI: 1720344419
Provider Name (Legal Business Name): QUANTUM BUSINESS DEVELOPMENT,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 16TH AVE 108
HIALEAH FL
33012-4654
US

IV. Provider business mailing address

3750 W 16TH AVE 108
HIALEAH FL
33012-4654
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-2887
  • Fax: 305-512-9182
Mailing address:
  • Phone: 305-512-2887
  • Fax: 305-512-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. ADEILSON JORGE
Title or Position: PRESIDENT
Credential:
Phone: 305-512-2887