Provider Demographics
NPI:1972225605
Name:LORENZO QUINTANA, RAIZA (PA)
Entity Type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:LORENZO QUINTANA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 SW 149TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7761
Mailing Address - Country:US
Mailing Address - Phone:305-613-9296
Mailing Address - Fax:
Practice Address - Street 1:3200 SW 60TH CT STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4070
Practice Address - Country:US
Practice Address - Phone:305-662-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant