Provider Demographics
NPI:1083245294
Name:QUINTANA, DIEGO JOSE (SA-C)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:JOSE
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18041 BISCAYNE BLVD APT 1902
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5251
Mailing Address - Country:US
Mailing Address - Phone:786-858-9178
Mailing Address - Fax:
Practice Address - Street 1:18041 BISCAYNE BLVD APT 1902
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-5251
Practice Address - Country:US
Practice Address - Phone:786-858-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19-478246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty