Provider Demographics
NPI:1972630184
Name:CENTURION QUINTANA & ASSOCIATES MDS PA
Entity Type:Organization
Organization Name:CENTURION QUINTANA & ASSOCIATES MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-751-0007
Mailing Address - Street 1:9526 NE 2ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2750
Mailing Address - Country:US
Mailing Address - Phone:305-751-0007
Mailing Address - Fax:305-754-4947
Practice Address - Street 1:9526 NE 2ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2750
Practice Address - Country:US
Practice Address - Phone:305-751-0007
Practice Address - Fax:305-754-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056481800Medicaid
FLD50643Medicare UPIN
FL056481800Medicaid