Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | ME59703 | FL |
NPI | 1376566802 |
---|---|
Provider Name | Dr. Ileana R Perez-Quintairos |
First Address | South Miami, FL 33143-4823 |
Second Address | South Miami, FL 33143-4823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F92489 | (02) | FL |