MEDICARE: MELINA ANDREA QUINTAR-MOORE

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	106H00000X	Marriage & Family Therapist	MT 1989	FL

General Provider Information

NPI Number	:	1134374812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINA ANDREA QUINTAR-MOORE

Provider Business Mailing Address
First Line	:	7710 NW 71ST CT STE 206
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-2931
Country	:	US
Telephone Number	:	954-720-4350
Fax Number	:	954-720-1009

Provider Business Practice Location Address
First Line	:	7710 NW 71ST CT STE 206
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-2931
Country	:	US
Telephone Number	:	954-720-4350
Fax Number	:	954-720-1009

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

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	11/24/2008

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