Provider Demographics
NPI:1700440757
Name:QUINTERO, IVAN (ND)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31919 1ST AVE S STE 105
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5258
Mailing Address - Country:US
Mailing Address - Phone:206-717-5644
Mailing Address - Fax:
Practice Address - Street 1:31919 1ST AVE S STE 105
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5258
Practice Address - Country:US
Practice Address - Phone:206-717-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60949852175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath