Provider Demographics
NPI:1073714432
Name:QUINTANA, RODOLFO A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:A
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5622
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5622
Mailing Address - Country:US
Mailing Address - Phone:956-630-9454
Mailing Address - Fax:956-630-9447
Practice Address - Street 1:1801 S 5TH ST STE 122
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2915
Practice Address - Country:US
Practice Address - Phone:956-630-9454
Practice Address - Fax:956-630-9447
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32103103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196104702Medicaid
TX8F22041Medicare PIN