Healthcare Provider Details

I. General information

NPI: 1912861071
Provider Name (Legal Business Name): ENRIQUE QUINTERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4982 GEM ST
LAS CRUCES NM
88012-9452
US

IV. Provider business mailing address

4982 GEM ST
LAS CRUCES NM
88012-9452
US

V. Phone/Fax

Practice location:
  • Phone: 915-487-6578
  • Fax:
Mailing address:
  • Phone: 915-487-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number189271
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: