MEDICARE: HAZEL MARIE 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	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1841154366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAZEL MARIE QUINTANA

Provider Business Mailing Address
First Line	:	12230 PELICANO DRIVE
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79936
Country	:	US
Telephone Number	:	915-613-5255
Fax Number	:	915-701-2845

Provider Business Practice Location Address
First Line	:	12230 PELICANO DRIVE
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79936
Country	:	US
Telephone Number	:	915-613-5255
Fax Number	:	915-701-2845

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ HAZEL MARIE QUINTANA ” Practice Location

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