Provider Demographics
NPI:1134374812
Name:QUINTAR-MOORE, MELINA ANDREA
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:ANDREA
Last Name:QUINTAR-MOORE
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 1:7710 NW 71ST CT STE 206
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2931
Mailing Address - Country:US
Mailing Address - Phone:954-720-4350
Mailing Address - Fax:954-720-1009
Practice Address - Street 1:7710 NW 71ST CT STE 206
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2931
Practice Address - Country:US
Practice Address - Phone:954-720-4350
Practice Address - Fax:954-720-1009
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist