Healthcare Provider Details

I. General information

NPI: 1003547878
Provider Name (Legal Business Name): NATHALIA QUINTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST
MIAMI FL
33173-3012
US

IV. Provider business mailing address

2090 BAYBERRY DR
PEMBROKE PINES FL
33024-1402
US

V. Phone/Fax

Practice location:
  • Phone: 305-508-5580
  • Fax:
Mailing address:
  • Phone: 786-873-5948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: