Healthcare Provider Details

I. General information

NPI: 1790094175
Provider Name (Legal Business Name): JOEL ALFREDO QUINTANA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 11/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 SW 149TH AVE B216
MIAMI FL
33193-3144
US

IV. Provider business mailing address

8002 SW 149TH AVE B216
MIAMI FL
33193-3144
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-6178
  • Fax: 305-441-2883
Mailing address:
  • Phone: 305-979-6178
  • Fax: 305-441-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA45867
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number698778920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: