Provider Demographics
NPI:1790798098
Name:QUINTANA, OMAR
Entity Type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
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:ST.40 QQ-6
Mailing Address - Street 2:JARDINES DEL CARIBE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2636
Mailing Address - Country:US
Mailing Address - Phone:787-651-4312
Mailing Address - Fax:787-651-4313
Practice Address - Street 1:JARDINES DEL CARIBE
Practice Address - Street 2:ST.40 QQ-6
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2636
Practice Address - Country:US
Practice Address - Phone:787-651-4312
Practice Address - Fax:787-651-4313
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2977183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician