Provider Demographics
NPI:1932643442
Name:GOMEZ QUINTANA, ARQUELYS
Entity Type:Individual
Prefix:
First Name:ARQUELYS
Middle Name:
Last Name:GOMEZ QUINTANA
Suffix:
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 1:13411 SW 110TH TER # 33186
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4352
Mailing Address - Country:US
Mailing Address - Phone:786-290-1828
Mailing Address - Fax:
Practice Address - Street 1:13411 SW 110TH TER # 33186
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4352
Practice Address - Country:US
Practice Address - Phone:786-290-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-52677103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst