Healthcare Provider Details

I. General information

NPI: 1568977551
Provider Name (Legal Business Name): KEVIN QUINTEROS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 NW FEDERAL HWY STE 173
STUART FL
34994-1019
US

IV. Provider business mailing address

1770 13TH AVE N
LAKE WORTH FL
33460-1712
US

V. Phone/Fax

Practice location:
  • Phone: 772-362-9878
  • Fax: 772-362-9879
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: