Provider Demographics
NPI:1992759906
Name:QUINTERO, DIANA REBECA (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:REBECA
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:2018 CLINCH AVENUE
Practice Address - Street 2:SOUTH TOWER 1ST FLOOR
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-3791
Practice Address - Country:US
Practice Address - Phone:865-637-8481
Practice Address - Fax:865-246-7560
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN559062080P0214X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029278Medicaid
WI1992759906Medicaid
TNQ029278Medicaid
WI34206100Medicaid
TNQ029278Medicaid
H62519Medicare UPIN
WI34206100Medicaid