Provider Demographics
NPI:1528609971
Name:QUINTANA, MARTHA PATRICIA (RN,BSN,PHN, CDE)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:PATRICIA
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:RN,BSN,PHN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SHADY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2531
Mailing Address - Country:US
Mailing Address - Phone:831-840-2136
Mailing Address - Fax:831-722-2462
Practice Address - Street 1:85 NEILSON ST STE 201
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2485
Practice Address - Country:US
Practice Address - Phone:831-763-6445
Practice Address - Fax:831-722-2462
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365693163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator