Healthcare Provider Details

I. General information

NPI: 1043453855
Provider Name (Legal Business Name): ADA REGINA QUINTANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 SW 30TH AVE STE 101
POMPANO BEACH FL
33069-4887
US

IV. Provider business mailing address

2120 L ST NW SUITE 200
WASHINGTON DC
20037-1527
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-6770
  • Fax: 800-330-6770
Mailing address:
  • Phone: 202-715-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD043332
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: