Provider Demographics
NPI:1912370487
Name:QUINONEZ, NATASHA I
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:QUINONEZ
Suffix:I
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 1:12013 FOUNTAINBROOK BOULVEVARD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825
Mailing Address - Country:US
Mailing Address - Phone:407-936-5075
Mailing Address - Fax:
Practice Address - Street 1:12013 FOUNTAINBROOK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7043
Practice Address - Country:US
Practice Address - Phone:407-936-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other