Provider Demographics
NPI:1619797073
Name:QUINTANAR, STEPHANIE
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:QUINTANAR
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 1:195 S BROADWAY ST STE 205
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4656
Mailing Address - Country:US
Mailing Address - Phone:805-552-5239
Mailing Address - Fax:
Practice Address - Street 1:195 S BROADWAY ST STE 205
Practice Address - Street 2:
Practice Address - City:ORCUTT
Practice Address - State:CA
Practice Address - Zip Code:93455-4656
Practice Address - Country:US
Practice Address - Phone:805-552-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health