Provider Demographics
NPI:1699420133
Name:QUINTANILLA, FRANCISCO LORENZO
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:LORENZO
Last Name:QUINTANILLA
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 1:420 SW 12TH AVE APT 1105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2466
Mailing Address - Country:US
Mailing Address - Phone:786-212-3096
Mailing Address - Fax:
Practice Address - Street 1:420 SW 12TH AVE APT 1105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2466
Practice Address - Country:US
Practice Address - Phone:786-212-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-192454106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician