Provider Demographics
NPI:1902528755
Name:QUINTANA, SOFIA JEANETTE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:SOFIA
Middle Name:JEANETTE
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:3521 EAGLES HILL RDG
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6483
Mailing Address - Country:US
Mailing Address - Phone:636-395-1722
Mailing Address - Fax:
Practice Address - Street 1:3521 EAGLES HILL RDG
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6483
Practice Address - Country:US
Practice Address - Phone:636-395-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant