Provider Demographics
NPI:1558535591
Name:QUINTINA B. CORTEZA MD PA
Entity Type:Organization
Organization Name:QUINTINA B. CORTEZA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINTINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CORTEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-314-3436
Mailing Address - Street 1:401 E. NORTH BLVD
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:352-314-3436
Mailing Address - Fax:352-314-8638
Practice Address - Street 1:401 E. NORTH BLVD
Practice Address - Street 2:SUITE 102A
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-314-3436
Practice Address - Fax:352-314-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066395207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377061300Medicaid
FLB69104Medicare UPIN
FLDR217AMedicare UPIN
FL377061300Medicaid