=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689364077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEX AMILCAR QUINONEZ NREMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2023
-----------------------------------------------------
Last Update Date | 05/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9925 GILLESPIE DR # 4100
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75025-7534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-891-5460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2515 COUNTY ROAD 2704
-----------------------------------------------------
City | CADDO MILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75135-6141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-579-2724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146N00000X
-----------------------------------------------------
Taxonomy Name | Basic Emergency Medical Technician
-----------------------------------------------------
License Number | E3509717
-----------------------------------------------------
License Number State |
-----------------------------------------------------