Provider Demographics
NPI:1376566802
Name:PEREZ-QUINTAIROS, ILEANA R (MD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:R
Last Name:PEREZ-QUINTAIROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ILEANA
Other - Middle Name:R
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6310 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4823
Mailing Address - Country:US
Mailing Address - Phone:305-669-2799
Mailing Address - Fax:305-662-5895
Practice Address - Street 1:6310 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4823
Practice Address - Country:US
Practice Address - Phone:305-669-2799
Practice Address - Fax:305-662-5895
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59703207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF92489Medicare UPIN
FL26274CMedicare ID - Type Unspecified