Provider Demographics
NPI:1710305909
Name:CRUZ QUINTERO, CARMEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:
Last Name:CRUZ QUINTERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5213
Mailing Address - Country:US
Mailing Address - Phone:646-261-9150
Mailing Address - Fax:
Practice Address - Street 1:5917 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5188
Practice Address - Country:US
Practice Address - Phone:718-404-9109
Practice Address - Fax:718-334-6277
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY461073163WS0200X
NY382548363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WS0200XNursing Service ProvidersRegistered NurseSchool