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NPI Code Detail

MEDICARE: QUANTARA CLINICAL & DIAGNOSTIC CENTER LLC

MEDICARE: QUANTARA CLINICAL & DIAGNOSTIC CENTER LLC
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
1261QH0100XHealth Service Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11427618156OTHERFLINSURANCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831051721
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUANTARA CLINICAL & DIAGNOSTIC CENTER LLC
Provider Business Mailing Address
First Line : 6300 N WICKHAM RD STE 103-526
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-2028
Country : US
Telephone Number : 321-352-6609
Fax Number : 321-400-8832
Provider Business Practice Location Address
First Line : 6300 N WICKHAM RD STE 103-526
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-2028
Country : US
Telephone Number : 321-400-8871
Fax Number : 772-212-8697
Authorized Official
Title or Position : DIRECTOR
Name : MS. JINNAIL MONIQUE SESSIONS-HOUSTON
Credential : APRN
Telephone Number : 321-352-6609
Provider Enumeration Date : 11/29/2025
Last Update Date : 12/09/2025

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Directions to “QUANTARA CLINICAL & DIAGNOSTIC CENTER LLC ” Practice Location

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