Provider Demographics
NPI:1215482815
Name:QUINTERO, MARISOL
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 W 44TH PL APT 231
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7838
Mailing Address - Country:US
Mailing Address - Phone:305-299-5612
Mailing Address - Fax:
Practice Address - Street 1:1555 W 44TH PL APT 231
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7838
Practice Address - Country:US
Practice Address - Phone:305-299-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker