Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 25MA079099 | NJ |
NPI | 1174684104 |
---|---|
Provider Name | Juliette Quintero Solivan |
First Address | Red Bank, NJ 07701 |
Second Address | New Brunswick, NJ 08901-1928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0085481 | (05) | NJ |
I48065 | (02) | NJ |