Provider Demographics
NPI:1679246227
Name:MANSO QUINONES, TERESITA
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:
Last Name:MANSO QUINONES
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 1:4939 SW 144TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5062
Mailing Address - Country:US
Mailing Address - Phone:786-597-0634
Mailing Address - Fax:
Practice Address - Street 1:4939 SW 144TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-5062
Practice Address - Country:US
Practice Address - Phone:786-597-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician