Provider Demographics
NPI:1225308539
Name:QUINTERO, HEAVENLY RUBY (LMT)
Entity Type:Individual
Prefix:
First Name:HEAVENLY
Middle Name:RUBY
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 KULIKE RD
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5945
Mailing Address - Country:US
Mailing Address - Phone:808-463-6477
Mailing Address - Fax:
Practice Address - Street 1:390 KULIKE RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5945
Practice Address - Country:US
Practice Address - Phone:808-463-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 8069171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor