Healthcare Provider Details

I. General information

NPI: 1932013117
Provider Name (Legal Business Name): NATALIA QUINTERO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 MAIN ST
PORT JEFFERSON NY
11777-2278
US

IV. Provider business mailing address

107 RED OAK CT
PORT JEFFERSON NY
11777-1905
US

V. Phone/Fax

Practice location:
  • Phone: 631-802-6126
  • Fax:
Mailing address:
  • Phone: 516-668-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: