Provider Demographics
NPI:1407592934
Name:QUINTANA, RAIDON (MAT, ATC)
Entity type:Individual
Prefix:
First Name:RAIDON
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16755 W LAKE HOUSTON PKWY APT 12113
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-6374
Mailing Address - Country:US
Mailing Address - Phone:559-347-8807
Mailing Address - Fax:
Practice Address - Street 1:16755 W LAKE HOUSTON PKWY APT 12113
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6374
Practice Address - Country:US
Practice Address - Phone:559-347-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-08
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program