Healthcare Provider Details

I. General information

NPI: 1053262022
Provider Name (Legal Business Name): AMANDA QUINTANA ALBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE STE 103
PALM SPRINGS FL
33461-2502
US

IV. Provider business mailing address

2042 SE ESTERBROOK ST
PORT SAINT LUCIE FL
34983-4697
US

V. Phone/Fax

Practice location:
  • Phone: 561-729-6631
  • Fax: 561-771-6630
Mailing address:
  • Phone: 561-671-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: