Provider Demographics
NPI:1649320623
Name:OUINTANA, ROBERT (SLP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:OUINTANA
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:NM
Mailing Address - Zip Code:87567-0460
Mailing Address - Country:US
Mailing Address - Phone:505-982-8561
Mailing Address - Fax:505-989-1740
Practice Address - Street 1:6A ENTRADA DEL JARDIN
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:NM
Practice Address - Zip Code:87567
Practice Address - Country:US
Practice Address - Phone:505-929-4648
Practice Address - Fax:505-424-8488
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10028404Medicaid
NMA1098Medicaid