Provider Demographics
NPI:1477112514
Name:QUINTELA, RUBEN ARTURO
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:ARTURO
Last Name:QUINTELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23316 SW 113TH PSGE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7153
Mailing Address - Country:US
Mailing Address - Phone:786-443-5953
Mailing Address - Fax:
Practice Address - Street 1:14000 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3003
Practice Address - Country:US
Practice Address - Phone:305-592-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily