Healthcare Provider Details

I. General information

NPI: 1467518100
Provider Name (Legal Business Name): MELISSA YAHAIRA DE JESUS QUINN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA YAHAIRA QUINN M.D.

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16019 VIA SHAVANO
SAN ANTONIO TX
78249-2370
US

IV. Provider business mailing address

16019 VIA SHAVANO
SAN ANTONIO TX
78249-2370
US

V. Phone/Fax

Practice location:
  • Phone: 210-696-9292
  • Fax: 210-690-8815
Mailing address:
  • Phone: 210-696-9292
  • Fax: 210-690-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMT187089
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberN4011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: