Provider Demographics
NPI:1023708088
Name:QUINTAS, TREVOR ALWYN JR
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:ALWYN
Last Name:QUINTAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6274
Mailing Address - Country:US
Mailing Address - Phone:240-437-8282
Mailing Address - Fax:
Practice Address - Street 1:1140 3RD ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6274
Practice Address - Country:US
Practice Address - Phone:240-437-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies