Provider Demographics
NPI:1407169667
Name:QUEVEDO-MARTINEZ, JOAN MARIE
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MARIE
Last Name:QUEVEDO-MARTINEZ
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 1:10963 NW 70TH CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076
Mailing Address - Country:US
Mailing Address - Phone:561-213-3747
Mailing Address - Fax:954-206-0206
Practice Address - Street 1:10963 NW 70TH CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3872
Practice Address - Country:US
Practice Address - Phone:561-213-4757
Practice Address - Fax:954-206-0206
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency