Provider Demographics
NPI:1760066997
Name:QUINTERO, OMAR ARTURO (CRNA)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:ARTURO
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3197 W 79TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3849
Mailing Address - Country:US
Mailing Address - Phone:786-506-3060
Mailing Address - Fax:
Practice Address - Street 1:3197 W 79TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3849
Practice Address - Country:US
Practice Address - Phone:786-506-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11013100OtherBOARD OF NURSING