Healthcare Provider Details

I. General information

NPI: 1386220416
Provider Name (Legal Business Name): MIRIELA QUINTERO MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 BIRD RD
MIAMI FL
33155-4825
US

IV. Provider business mailing address

9030 SW 125TH AVE APT 301E
MIAMI FL
33186-7163
US

V. Phone/Fax

Practice location:
  • Phone: 786-216-7382
  • Fax:
Mailing address:
  • Phone: 786-442-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: