Provider Demographics
NPI:1184137358
Name:QUINTERO, JASMIN GRACE
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:GRACE
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12130 PEBBLE HILLS BLVD APT C302
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2147
Mailing Address - Country:US
Mailing Address - Phone:915-304-6899
Mailing Address - Fax:
Practice Address - Street 1:12130 PEBBLE HILLS BLVD APT C302
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2147
Practice Address - Country:US
Practice Address - Phone:915-304-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician