1932921673 NPI number — QUINTANA NUTRITIONAL SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932921673 NPI number — QUINTANA NUTRITIONAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUINTANA NUTRITIONAL SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932921673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-8428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-432-3195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE MEDICA SAN CRISTOBAL
Provider Second Line Business Practice Location Address:
3007 AVE SAN CRISTOBAL STE 314
Provider Business Practice Location Address City Name:
COTO LAUREL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780-2280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-432-3195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2024

Additional Information

Authorized Official

Authorized Official Last Name:
QUINTANA FILIPPETTI
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT / OWNER
Authorized Official Telephone Number:
787-432-6399

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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