=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770244246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAILEEN QUINTANA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2022
-----------------------------------------------------
Last Update Date | 10/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB. ROYAL TOWN 4-26 CALLE 41
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PUERTO RICO
-----------------------------------------------------
Zip | 00956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-664-0549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB. ROYAL TOWN 4-26 CALLE 41
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PUERTO RICO
-----------------------------------------------------
Zip | 00956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376G00000X
-----------------------------------------------------
Taxonomy Name | Nursing Home Administrator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------