Healthcare Provider Details

I. General information

NPI: 1972925253
Provider Name (Legal Business Name): KETTYELENA QUINDEMIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 06/09/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

321 SW 120TH AVE
MIAMI FL
33184-1640
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8210
  • Fax: 862-714-9737
Mailing address:
  • Phone: 786-271-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9274074
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9274074
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberRN10025381
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: