MEDICARE: MR. GEORGE JESUS QUINTERO

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1326484502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE JESUS QUINTERO

Provider Business Mailing Address
First Line	:	6660 SW 130TH AVE
Second Line	:	1704
City	:	MIAMI
State	:	FL
Zip	:	33183-5215
Country	:	US
Telephone Number	:	305-322-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 SW 130TH AVE
Second Line	:	1704
City	:	MIAMI
State	:	FL
Zip	:	33183-5215
Country	:	US
Telephone Number	:	305-322-1229
Fax Number	:

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

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	05/15/2013

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