MEDICARE: AMANDA QUINTANA ALBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1053262022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA QUINTANA ALBA

Provider Business Mailing Address
First Line	:	2042 SE ESTERBROOK ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-4697
Country	:	US
Telephone Number	:	561-671-0362
Fax Number	:

Provider Business Practice Location Address
First Line	:	2042 SE ESTERBROOK ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-4697
Country	:	US
Telephone Number	:	561-671-0362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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