Provider Demographics
NPI:1801972641
Name:QUINTERO, MARIETA DE LOURDES (MD)
Entity type:Individual
Prefix:MRS
First Name:MARIETA
Middle Name:DE LOURDES
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 NORTH BROADWAY
Mailing Address - Street 2:SUITE 308A
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-375-2229
Mailing Address - Fax:914-965-2044
Practice Address - Street 1:970 NORTH BROADWAY
Practice Address - Street 2:SUITE 308A
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-375-2229
Practice Address - Fax:914-965-2044
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233433208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY615X81OtherBLUE CROSS
NY02616773Medicaid
NYP3481500OtherOXFORD