Provider Demographics
NPI:1245819929
Name:ALICEA QUINTANA, FERNANDO GABRIEL (DO)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:GABRIEL
Last Name:ALICEA QUINTANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3960
Mailing Address - Country:US
Mailing Address - Phone:585-467-7070
Mailing Address - Fax:585-467-7702
Practice Address - Street 1:2164 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3960
Practice Address - Country:US
Practice Address - Phone:585-467-7070
Practice Address - Fax:585-467-7702
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013441-01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor