Provider Demographics
NPI:1891513735
Name:QUINTANA, ASHANTI ITZEL
Entity type:Individual
Prefix:
First Name:ASHANTI
Middle Name:ITZEL
Last Name:QUINTANA
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 1:748 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1126
Mailing Address - Country:US
Mailing Address - Phone:541-390-7176
Mailing Address - Fax:
Practice Address - Street 1:748 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1126
Practice Address - Country:US
Practice Address - Phone:541-390-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No124Q00000XDental ProvidersDental Hygienist