Healthcare Provider Details

I. General information

NPI: 1649354747
Provider Name (Legal Business Name): JAIME E QUINTEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 W GRANADA BLVD SUITE 1A
ORMOND BEACH FL
32174-1851
US

IV. Provider business mailing address

112 DEEPWOODS WAY
ORMOND BEACH FL
32174
US

V. Phone/Fax

Practice location:
  • Phone: 386-615-4414
  • Fax: 386-615-8466
Mailing address:
  • Phone: 386-316-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME77188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: