Provider Demographics
NPI:1487549069
Name:QUINTANA AVILA, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:QUINTANA AVILA
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 1:213 S SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2579
Mailing Address - Country:US
Mailing Address - Phone:570-468-6553
Mailing Address - Fax:
Practice Address - Street 1:1402 WASHBURN ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2429
Practice Address - Country:US
Practice Address - Phone:570-343-2591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program