Provider Demographics
NPI:1124812938
Name:VIDARTE QUINTANA, FABIAN ANDRES (MD)
Entity type:Individual
Prefix:
First Name:FABIAN
Middle Name:ANDRES
Last Name:VIDARTE QUINTANA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 CALLE IGUALDAD
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2316
Mailing Address - Country:US
Mailing Address - Phone:787-702-4231
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 3 KM. 8.3 AVE 65 DE INFANTERIA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program