Provider Demographics
NPI:1437664661
Name:PAZ QUINTERO, LESLIE K
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:K
Last Name:PAZ QUINTERO
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 1:5207 MONZA CT
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-5099
Mailing Address - Country:US
Mailing Address - Phone:786-234-9664
Mailing Address - Fax:
Practice Address - Street 1:5207 MONZA CT
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-5099
Practice Address - Country:US
Practice Address - Phone:786-234-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100947171M00000X
FL1-21-55375103K00000X
FL0-19-10047106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst