Provider Demographics
NPI:1962694836
Name:QUINTANA & PEREZ MD PA
Entity type:Organization
Organization Name:QUINTANA & PEREZ MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-383-2122
Mailing Address - Street 1:800 CENTURY MEDICAL DR
Mailing Address - Street 2:STE B
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2151
Mailing Address - Country:US
Mailing Address - Phone:321-383-2122
Mailing Address - Fax:321-383-4119
Practice Address - Street 1:800 CENTURY MEDICAL DR
Practice Address - Street 2:STE B
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2151
Practice Address - Country:US
Practice Address - Phone:321-383-2122
Practice Address - Fax:321-383-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE31294Medicare UPIN
FLE86960Medicare UPIN
FLQ15872Medicare UPIN