Provider Demographics
NPI:1720398068
Name:QUINTERO, JUDY
Entity Type:Individual
Prefix:MRS
First Name:JUDY
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 1:312 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-4011
Mailing Address - Country:US
Mailing Address - Phone:979-543-4439
Mailing Address - Fax:979-543-4439
Practice Address - Street 1:312 AVENUE F
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-4011
Practice Address - Country:US
Practice Address - Phone:979-543-4439
Practice Address - Fax:979-543-4439
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187429164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse