Provider Demographics
NPI:1699216176
Name:QUANTUM EXPOSURE
Entity Type:Organization
Organization Name:QUANTUM EXPOSURE
Other - Org Name:ANDROSPA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RESTREPO
Authorized Official - Suffix:
Authorized Official - Credentials:CLS, EMT
Authorized Official - Phone:800-214-4001
Mailing Address - Street 1:3180 S OCEAN DR
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7255
Mailing Address - Country:US
Mailing Address - Phone:800-214-4001
Mailing Address - Fax:
Practice Address - Street 1:3180 S OCEAN DR
Practice Address - Street 2:SUITE 1105
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7255
Practice Address - Country:US
Practice Address - Phone:800-214-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL594896919332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site