Healthcare Provider Details

I. General information

NPI: 1679014898
Provider Name (Legal Business Name): QUIRANTES ORTHOPEDICS RX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4258 W 12TH AVE
HIALEAH FL
33012-4108
US

IV. Provider business mailing address

4258 W 12TH AVE
HIALEAH FL
33012-4108
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-6181
  • Fax:
Mailing address:
  • Phone: 305-821-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateFL

VIII. Authorized Official

Name: OLGA L QUIRANTES
Title or Position: PRESIDENT
Credential: ORF 92
Phone: 786-925-7646