Provider Demographics
NPI:1164139309
Name:QUINTERO, JAMES GUZMAN (ASTR'S AOS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GUZMAN
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:ASTR'S AOS
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:GUZMAN
Other - Last Name:QUINTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASTR'S AOS
Mailing Address - Street 1:2075 SANDWOOD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-3083
Mailing Address - Country:US
Mailing Address - Phone:928-230-3287
Mailing Address - Fax:
Practice Address - Street 1:2152 MCCULLOCH BLVD N STE F
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6811
Practice Address - Country:US
Practice Address - Phone:928-230-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-18347225700000X
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist