Individual
MARIA JOSEFINA QUINTANILLA-DIECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
036154214
IL
207N00000X
Dermatology Physician
4301091563
MI
207N00000X
Dermatology Physician
N9937
TX
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
036154214
IL
207ND0101X
MOHS-Micrographic Surgery Physician
4301091563
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
283860903
ARC TRAVIS MEDICAID
TX
01
—
283860904
ARC ROT MEDICAID
TX
01
—
372614YKXV
ARC TRAVIS MEDICARE
TX
01
—
372614YKXY
ARC ROT MEDICARE
TX
01
—
4301091563
MICHIGAN LIMITED EDUCATION LICENSE
MI
Enumeration date
05/19/2008
Last updated
06/30/2021
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