Provider Demographics
NPI:1932606597
Name:QUINTANA, ELBA E
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:E
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELBA
Other - Middle Name:E
Other - Last Name:QUINTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:349 AVE HOSTOS SANTANDER SECURITIES PLAZA
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-265-2300
Mailing Address - Fax:787-831-1714
Practice Address - Street 1:349 HOSTOS SANTANDER SECURITIES PLAZA
Practice Address - Street 2:SUITE 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-2300
Practice Address - Fax:787-831-1714
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25307163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice