Provider Demographics
NPI:1992397012
Name:QUINTERO, MARIA STELLA (LMBT)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:STELLA
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19400 ONE NORMAN BLVD APT O
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5891
Mailing Address - Country:US
Mailing Address - Phone:130-571-3256
Mailing Address - Fax:
Practice Address - Street 1:19400 ONE NORMAN BLVD APT O
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5891
Practice Address - Country:US
Practice Address - Phone:130-571-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95409225700000X
NC19088225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty