Provider Demographics
NPI:1447863949
Name:QUINTANA, KAYTLIN LARAE
Entity type:Individual
Prefix:
First Name:KAYTLIN
Middle Name:LARAE
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 1:1515 S YALE ST APT 5-2A
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6357
Mailing Address - Country:US
Mailing Address - Phone:480-359-8460
Mailing Address - Fax:
Practice Address - Street 1:1515 S YALE ST APT 5-2A
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6357
Practice Address - Country:US
Practice Address - Phone:480-359-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program