Healthcare Provider Details

I. General information

NPI: 1104636992
Provider Name (Legal Business Name): SANDRA IVETTE QUINTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. # 2 - KM 156.5, SUITE 402 EDIFICIO OFFICE PARK I
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

36 URB PARQUE LA ARBOLDA
AGUADILLA PR
00603
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-2899
  • Fax:
Mailing address:
  • Phone: 787-214-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000489
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: