Healthcare Provider Details

I. General information

NPI: 1164040358
Provider Name (Legal Business Name): EDUARDO JOSE QUINTANILLA JEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 N VETERANS BLVD STE 5
EAGLE PASS TX
78852-4456
US

IV. Provider business mailing address

1975 N VETERANS BLVD STE 5
EAGLE PASS TX
78852-4456
US

V. Phone/Fax

Practice location:
  • Phone: 830-773-9449
  • Fax:
Mailing address:
  • Phone: 830-773-9449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU7933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: