Provider Demographics
NPI:1215483896
Name:QUINTANILLA, JANET (DOM, DIPL OM)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:DOM, DIPL OM
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:VIALPANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOM, DIPL OM
Mailing Address - Street 1:1736 DEAN MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2488 CALLE DE GUADALUPE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-618-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDOM1111171100000X
NM1111171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist