Healthcare Provider Details

I. General information

NPI: 1770244246
Provider Name (Legal Business Name): JAILEEN QUINTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. JAILEEN QUINTANA

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 10/28/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. ROYAL TOWN 4-26 CALLE 41
BAYAMON PUERTO RICO
00956
US

IV. Provider business mailing address

URB. ROYAL TOWN 4-26 CALLE 41
BAYAMON PUERTO RICO
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-664-0549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: