=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679014898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUIRANTES ORTHOPEDICS RX CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2017
-----------------------------------------------------
Last Update Date | 10/30/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4258 W 12TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-821-6181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4258 W 12TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-4108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-821-6181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | OLGA L QUIRANTES
-----------------------------------------------------
Credential | ORF 92
-----------------------------------------------------
Telephone | 786-925-7646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------