Provider Demographics
NPI:1649585373
Name:LUIS C QUINTERO MD PA
Entity Type:Organization
Organization Name:LUIS C QUINTERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-666-9963
Mailing Address - Street 1:420 S DIXIE HWY STE 4E
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2232
Mailing Address - Country:US
Mailing Address - Phone:305-666-9963
Mailing Address - Fax:305-666-3768
Practice Address - Street 1:420 S DIXIE HWY STE 4E
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2232
Practice Address - Country:US
Practice Address - Phone:305-666-9963
Practice Address - Fax:305-666-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046763400Medicaid
FL04122Medicare PIN
FLD61020Medicare UPIN