Healthcare Provider Details

I. General information

NPI: 1811494792
Provider Name (Legal Business Name): DUNILEIBY GONZALEZ QUINTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20621 SW 125TH CT
MIAMI FL
33177-5623
US

IV. Provider business mailing address

20621 SW 125TH CT
MIAMI FL
33177-5623
US

V. Phone/Fax

Practice location:
  • Phone: 786-805-2385
  • Fax: 305-742-2190
Mailing address:
  • Phone: 786-805-2385
  • Fax: 305-742-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: