Healthcare Provider Details

I. General information

NPI: 1871552729
Provider Name (Legal Business Name): MARIO A QUINTANILLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 FLYNN PKWY STE 307
CORPUS CHRISTI TX
78411-4384
US

IV. Provider business mailing address

5151 FLYNN PKWY STE 307
CORPUS CHRISTI TX
78411-4384
US

V. Phone/Fax

Practice location:
  • Phone: 361-993-4835
  • Fax: 361-993-7043
Mailing address:
  • Phone: 361-993-4835
  • Fax: 361-993-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberF1201
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberF1201
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: