Provider Demographics
NPI:1245797679
Name:QUINTANA SOSA, GRETTER
Entity Type:Individual
Prefix:
First Name:GRETTER
Middle Name:
Last Name:QUINTANA SOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 SW 145TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6785
Mailing Address - Country:US
Mailing Address - Phone:786-343-5126
Mailing Address - Fax:
Practice Address - Street 1:14101 SW 145TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6785
Practice Address - Country:US
Practice Address - Phone:786-343-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician