Organization
USA MEDDAC, RWBAHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL QUINTANA LPN (LICENSED PRACTICAL NURSE)
(520) 533-9034
Entity
Organization
Contact information
Practice address
2240 WINROW AVE, FORT HUACHUCA, AZ 85613
(520) 533-9034
Mailing address
2240 WINROW AVE, FORT HUACHUCA, AZ 85613
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
PN5193793
FL
Other
Enumeration date
02/12/2016
Last updated
02/12/2016
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