MEDICARE: SANDRA IVETTE QUINTANA

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	225X00000X	Occupational Therapist	000489	PR

General Provider Information

NPI Number	:	1104636992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA IVETTE QUINTANA

Provider Business Mailing Address
First Line	:	36 URB PARQUE LA ARBOLDA
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603
Country	:	US
Telephone Number	:	787-214-5822
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR. # 2 - KM 156.5, SUITE 402 EDIFICIO OFFICE PARK I
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680
Country	:	US
Telephone Number	:	787-833-2899
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	06/04/2026

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