Provider Demographics
NPI:1861696395
Name:QUINTANILLA, NORMA M (MD)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:M
Last Name:QUINTANILLA
Suffix:
Gender:F
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:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1907
Mailing Address - Country:US
Mailing Address - Phone:832-824-1866
Mailing Address - Fax:832-825-1032
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:AB1195
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-1866
Practice Address - Fax:832-825-1032
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6590207ZP0105X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0026864OtherINSTITUTIONAL PERMIT