Provider Demographics
NPI:1770074627
Name:QUINZADA, JORGE E
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:QUINZADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 SW 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3173
Mailing Address - Country:US
Mailing Address - Phone:305-773-5977
Mailing Address - Fax:
Practice Address - Street 1:18350 NW 2AVE
Practice Address - Street 2:
Practice Address - City:MIAMI, GARDENS,FL
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:305-756-9947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist