Healthcare Provider Details

I. General information

NPI: 1790945988
Provider Name (Legal Business Name): CURTIS MICHAEL QUINTANA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9640 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2217
US

IV. Provider business mailing address

10332 LAWTON ST NW
ALBUQUERQUE NM
87114-5595
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-4167
  • Fax:
Mailing address:
  • Phone: 505-814-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 2003-0032
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2003-0032
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: