Provider Demographics
NPI:1619722097
Name:QUINTERO, ENOLA
Entity Type:Individual
Prefix:
First Name:ENOLA
Middle Name:
Last Name: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 1:21735 SW 104TH CT APT 204
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1056
Mailing Address - Country:US
Mailing Address - Phone:786-288-1450
Mailing Address - Fax:
Practice Address - Street 1:21735 SW 104TH CT APT 204
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1056
Practice Address - Country:US
Practice Address - Phone:786-288-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician