Provider Demographics
NPI:1871521377
Name:QUINTANA, GUILLERMO R (MD)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:R
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 TROPICAL AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5078
Mailing Address - Country:US
Mailing Address - Phone:305-766-0499
Mailing Address - Fax:
Practice Address - Street 1:2695 TROPICAL AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5078
Practice Address - Country:US
Practice Address - Phone:305-766-0499
Practice Address - Fax:305-766-0499
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44368207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068917300Medicaid
FL068917300Medicaid
FLD80629Medicare UPIN