Provider Demographics
NPI:1902856438
Name:QUINTERO, JESUS FERNANDO (MD)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:FERNANDO
Last Name:QUINTERO
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 1:2161 E COMMERCIAL BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3810
Mailing Address - Country:US
Mailing Address - Phone:954-491-5187
Mailing Address - Fax:954-491-5217
Practice Address - Street 1:2161 E COMMERCIAL BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3810
Practice Address - Country:US
Practice Address - Phone:954-491-5187
Practice Address - Fax:954-491-5217
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251708600Medicaid
FL32622Medicare ID - Type Unspecified
FL251708600Medicaid