Provider Demographics
NPI:1790942969
Name:QUINTANA PADILLA, JAVIER (LPN)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:QUINTANA PADILLA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA PARAISO #1849 CALLE TERNURA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-487-5226
Mailing Address - Fax:
Practice Address - Street 1:PONCE AVE TITO CASTRO AL LADOS DE SAN LUCUS
Practice Address - Street 2:HOSPITAL SIQUIATRIA FORENCE #2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-487-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR030923164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse