Healthcare Provider Details

I. General information

NPI: 1972318491
Provider Name (Legal Business Name): PEDIATRIC URGENT CARE GROUP OF ORMOND BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 W GRANADA BLVD STE 1A
ORMOND BEACH FL
32174-1818
US

IV. Provider business mailing address

1688 W GRANADA BLVD STE 1A
ORMOND BEACH FL
32174-1818
US

V. Phone/Fax

Practice location:
  • Phone: 386-316-6276
  • Fax: 386-221-3503
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JAIME E QUINTEROS
Title or Position: MD, OWNER
Credential:
Phone: 386-425-4414