Provider Demographics
NPI:1598754178
Name:QUINTANA, JUAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9526 NE 2ND AVE
Mailing Address - Street 2:#102
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2750
Mailing Address - Country:US
Mailing Address - Phone:305-751-0007
Mailing Address - Fax:305-754-4947
Practice Address - Street 1:9526 NE 2ND AVE
Practice Address - Street 2:#102
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2750
Practice Address - Country:US
Practice Address - Phone:305-751-0007
Practice Address - Fax:305-754-4947
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME42763207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056481800Medicaid
FL650173899OtherTAX ID NUMBER
FL72601Medicare ID - Type Unspecified
FL056481800Medicaid