Healthcare Provider Details

I. General information

NPI: 1144181801
Provider Name (Legal Business Name): JESSICA QUINONES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 BLENHEIM RD
BALTIMORE MD
21212-1716
US

IV. Provider business mailing address

6411 BLENHEIM RD
BALTIMORE MD
21212-1716
US

V. Phone/Fax

Practice location:
  • Phone: 443-837-7880
  • Fax:
Mailing address:
  • Phone: 443-837-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA QUINONES
Title or Position: OWNER
Credential: MS, CNS, LDN
Phone: 443-837-7880