Provider Demographics
NPI:1770082778
Name:QUANTICO HEALTH SERVICES, CORP.
Entity type:Organization
Organization Name:QUANTICO HEALTH SERVICES, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-673-1142
Mailing Address - Street 1:PO BOX 3042
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3042
Mailing Address - Country:US
Mailing Address - Phone:787-673-1142
Mailing Address - Fax:
Practice Address - Street 1:6777 MARGINAL BIASCOCHEA
Practice Address - Street 2:ISLA VERDE MALL SUITE 218
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-7603
Practice Address - Country:US
Practice Address - Phone:787-331-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty