Provider Demographics
NPI:1689401747
Name:QUINTANA, SANTIAGO ZEPPELIN
Entity type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:ZEPPELIN
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 JUDITH LN SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-2238
Mailing Address - Country:US
Mailing Address - Phone:505-569-4592
Mailing Address - Fax:
Practice Address - Street 1:405 JUDITH LN SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2238
Practice Address - Country:US
Practice Address - Phone:505-569-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM519022575106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician