Healthcare Provider Details

I. General information

NPI: 1972630184
Provider Name (Legal Business Name): CENTURION QUINTANA & ASSOCIATES MDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9526 NE 2ND AVE SUITE 102
MIAMI SHORES FL
33138-2750
US

IV. Provider business mailing address

9526 NE 2ND AVE SUITE 102
MIAMI SHORES FL
33138-2750
US

V. Phone/Fax

Practice location:
  • Phone: 305-751-0007
  • Fax: 305-754-4947
Mailing address:
  • Phone: 305-751-0007
  • Fax: 305-754-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN A QUINTANA
Title or Position: OWNER
Credential: M.D.
Phone: 305-751-0007