Provider Demographics
NPI:1114978624
Name:QUINTERO, VICENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2967 OAK RUN PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5382
Mailing Address - Country:US
Mailing Address - Phone:830-626-5551
Mailing Address - Fax:830-626-5593
Practice Address - Street 1:2967 OAK RUN PKWY STE 210
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5382
Practice Address - Country:US
Practice Address - Phone:830-626-5551
Practice Address - Fax:830-626-5593
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2572207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149405601Medicaid
TXH38842Medicare UPIN
TX149405601Medicaid