Provider Demographics
NPI:1184340911
Name:QUINTANILLA, ALEXANDRINA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRINA
Middle Name:
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 FM 3168
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-4443
Mailing Address - Country:US
Mailing Address - Phone:956-689-8175
Mailing Address - Fax:
Practice Address - Street 1:700 N 1ST ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-1501
Practice Address - Country:US
Practice Address - Phone:956-689-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031914101Medicaid
TX245901001Medicaid
TX245901101Medicaid
TX245904041Medicaid
TX245904101Medicaid
TX245903102Medicaid
TX245901041Medicaid
TX245904002Medicaid
TX031914041Medicaid
TX031914001Medicaid
TX245903001Medicaid
TX245903041Medicaid
TX245903105Medicaid