Provider Demographics
NPI:1316719198
Name:IQ BOARD CERTIFIED SERVICES
Entity type:Organization
Organization Name:IQ BOARD CERTIFIED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IDELFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-510-1237
Mailing Address - Street 1:12695 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4707
Mailing Address - Country:US
Mailing Address - Phone:305-510-1237
Mailing Address - Fax:
Practice Address - Street 1:12695 SW 105TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4707
Practice Address - Country:US
Practice Address - Phone:305-510-1237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty