Provider Demographics
NPI:1366277287
Name:QUINTANAR, AUDRINA MARIA
Entity type:Individual
Prefix:
First Name:AUDRINA
Middle Name:MARIA
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 1:1806 ADAMS AVE SPC 11
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-1984
Mailing Address - Country:US
Mailing Address - Phone:619-966-0118
Mailing Address - Fax:
Practice Address - Street 1:200 S 5TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3013
Practice Address - Country:US
Practice Address - Phone:760-482-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)