Provider Demographics
NPI:1407153653
Name:QUINTANA, RICARDO (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9127 W RUSSELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1253
Mailing Address - Country:US
Mailing Address - Phone:702-878-0070
Mailing Address - Fax:702-209-2064
Practice Address - Street 1:9127 W RUSSELL RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1253
Practice Address - Country:US
Practice Address - Phone:702-878-0070
Practice Address - Fax:702-209-2064
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCRNA000438367500000X
FL9291434163W00000X
CA632895163W00000X
AZMSLR681580TX163W00000X
TX681580363L00000X
AZCRNA0754367500000X
FLARNP9291434367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1407153653Medicaid