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General NPI Number Information
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NPI Number | 1972772598
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Entity Type | Organization
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Legal Business Name | QUANTUM THERAPEUTICS, INC.
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 640 NE 124TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5523
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Country | US
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Telephone | 305-891-4114
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Fax | 305-895-6639
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Provider Business Mailing Address
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Address Line | 640 NE 124TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5523
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Country | US
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Telephone | 305-891-4114
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Fax | 305-895-6639
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CONSUELO MORENO
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Credential | PH.D.
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Telephone | 305-895-6639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW2895
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH2711
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License Number State | FL
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