Provider Demographics
NPI:1376028928
Name:QUINTANA MARTEL, ODILIA LISSET
Entity Type:Individual
Prefix:
First Name:ODILIA
Middle Name:LISSET
Last Name:QUINTANA MARTEL
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 1:854 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-4231
Mailing Address - Country:US
Mailing Address - Phone:786-484-3456
Mailing Address - Fax:
Practice Address - Street 1:854 E 24TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-4231
Practice Address - Country:US
Practice Address - Phone:786-484-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9435384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily