Healthcare Provider Details

I. General information

NPI: 1659474088
Provider Name (Legal Business Name): EMILIO DE QUESADA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 SW 120TH ST STE 101
MIAMI FL
33186-9115
US

IV. Provider business mailing address

9725 NW 117TH AVE FL 2
MEDLEY FL
33178-1212
US

V. Phone/Fax

Practice location:
  • Phone: 305-506-1930
  • Fax: 855-226-6633
Mailing address:
  • Phone: 954-432-0578
  • Fax: 954-432-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 82711
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: