Healthcare Provider Details

I. General information

NPI: 1518194869
Provider Name (Legal Business Name): KATHERINE QUINONES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2009
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SW FOUNTAINVIEW BLVD STE 105
PORT ST LUCIE FL
34986-4527
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 772-336-2818
  • Fax: 772-336-5313
Mailing address:
  • Phone: 772-336-2818
  • Fax: 772-336-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS14896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: