Healthcare Provider Details

I. General information

NPI: 1023972692
Provider Name (Legal Business Name): ROGER ALFREDO QUARANTA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MEADOWS BLVD
WESTON FL
33327-1805
US

IV. Provider business mailing address

1400 MEADOWS BLVD
WESTON FL
33327-1805
US

V. Phone/Fax

Practice location:
  • Phone: 305-497-6265
  • Fax:
Mailing address:
  • Phone: 305-497-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2984
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2984
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number21-558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: