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General NPI Number Information
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NPI Number | 1306534458
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Entity Type | Individual
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Provider Name | MATIAS MIGUEL QUINTANILLA MSN APRN FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 11/02/2025
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Provider Practice Location Address
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Address Line | 786 W PIONEER BLVD STE A
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City | MESQUITE
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State | NV
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Zip | 89027-8862
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Country | US
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Telephone | 702-345-5000
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Fax | 702-345-2000
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Provider Business Mailing Address
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Address Line | 6355 S BUFFALO DR FL 3
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City | LAS VEGAS
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State | NV
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Zip | 89113-2133
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Country | US
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Telephone | 702-216-3346
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11475617-4408
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 841346
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11475617-3102
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11475617-4405
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License Number State | UT
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