Organization
COUNTY OF COSTILLA
Active
Other names
Costilla County Public Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH QUINTANA MD (SUPERVISING MD)
(719) 672-3465
Entity
Organization
Contact information
Practice address
233 MAIN STREET, SUITE C., SAN LUIS, CO 81152
(719) 672-3465
Mailing address
PO BOX 99, SAN LUIS, CO 81152-0099
(719) 672-3465
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013044542
—
CO
Enumeration date
08/02/2021
Last updated
08/02/2021
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