Provider Demographics
NPI:1992101075
Name:QUINTERO, JACQUELINE O (DPM)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:O
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 LONGVIEW RUN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-6001
Mailing Address - Country:US
Mailing Address - Phone:332-331-2739
Mailing Address - Fax:
Practice Address - Street 1:4758 LONGVIEW RUN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-6001
Practice Address - Country:US
Practice Address - Phone:332-331-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06651213EP1101X, 213ES0131X
GAPOD001467213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery