MEDICARE: ENRIQUE 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	246ZC0007X	Surgical Assistant	189271	TX

General Provider Information

NPI Number	:	1912861071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE QUINTERO

Provider Business Mailing Address
First Line	:	4982 GEM ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-9452
Country	:	US
Telephone Number	:	915-487-6578
Fax Number	:

Provider Business Practice Location Address
First Line	:	4982 GEM ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-9452
Country	:	US
Telephone Number	:	915-487-6578
Fax Number	:

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

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

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Directions to “ ENRIQUE QUINTERO ” Practice Location

Language	Start Address	Practice Location

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