Provider Demographics
NPI:1093732620
Name:QUINTANILLA, MARIO (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:QUINTANILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5803
Mailing Address - Country:US
Mailing Address - Phone:832-810-3000
Mailing Address - Fax:
Practice Address - Street 1:3905 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5803
Practice Address - Country:US
Practice Address - Phone:832-810-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5506207R00000X, 207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139017121Medicaid
TX139017122Medicaid
TX139017118Medicaid
TX139017117Medicaid
TX139017120Medicaid
TX8C8820Medicare PIN
TX139017118Medicaid
TX139017117Medicaid
TX8C8822Medicare PIN
TX8C8821Medicare PIN
TX8C8819Medicare PIN