Provider Demographics
NPI:1013249739
Name:QUIM, MARINELLE VALDEZ DE LOS SANTOS (MD)
Entity Type:Individual
Prefix:
First Name:MARINELLE
Middle Name:VALDEZ DE LOS SANTOS
Last Name:QUIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MCWILLIAMS PL
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1609
Mailing Address - Country:US
Mailing Address - Phone:201-706-7175
Mailing Address - Fax:
Practice Address - Street 1:21 MCWILLIAMS PL
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1609
Practice Address - Country:US
Practice Address - Phone:201-706-7175
Practice Address - Fax:201-604-6553
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA092144002080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine