Provider Demographics
NPI:1982067401
Name:QUINTESSENTIAL FOOT CARE, PLLC
Entity Type:Organization
Organization Name:QUINTESSENTIAL FOOT CARE, PLLC
Other - Org Name:J QUINTERO PODIATRY, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:O
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:332-331-2739
Mailing Address - Street 1:4758 LONGVIEW RUN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-6001
Mailing Address - Country:US
Mailing Address - Phone:332-331-2739
Mailing Address - Fax:
Practice Address - Street 1:4758 LONGVIEW RUN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-6001
Practice Address - Country:US
Practice Address - Phone:332-331-2739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006651213E00000X
213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty