Provider Demographics
NPI:1760011548
Name:QUINTANA, MIGUEL ELISEO
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ELISEO
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 PARKSIDE PL APT 3J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4993
Mailing Address - Country:US
Mailing Address - Phone:347-304-6481
Mailing Address - Fax:347-304-6481
Practice Address - Street 1:3235 PARKSIDE PL APT 3J
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4993
Practice Address - Country:US
Practice Address - Phone:347-304-6481
Practice Address - Fax:347-304-6481
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program