Provider Demographics
NPI:1497492458
Name:QUINTANA, GWENDOLYN ANDERE (MD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:ANDERE
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BUTTERFLY RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-8024
Mailing Address - Country:US
Mailing Address - Phone:210-379-9479
Mailing Address - Fax:
Practice Address - Street 1:611 BUTTERFLY RIDGE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-8024
Practice Address - Country:US
Practice Address - Phone:210-379-9479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program