MEDICARE: DR. MARIO E. QUINTERO - AGUILO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	14807	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	20170C	OTHER	PR	PREFERRED MEDICARE CHOICE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	660606085	OTHER	PR	SERVICIOS DE SALUD BELLA
2	PE4613	OTHER	PR	PAN AMERICAN
3	100041	OTHER	PR	CRUZ AZUL
4	5106085	OTHER	PR	UIA
5	660606085	OTHER	PR	MEDICAL CARD SYSTEMS
6	221055	OTHER	PR	PREFFERRED UTI
7	6800165	OTHER	PR	HUMANA INSURANCE
9	22311	OTHER	PR	TRIPLE 2

General Provider Information

NPI Number	:	1164417150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO E. QUINTERO - AGUILO MD

Provider Business Mailing Address
First Line	:	PO BOX 294
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-0294
Country	:	US
Telephone Number	:	787-951-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	LAS FLORES 60 ENS. MARTINEZ
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-0000
Country	:	US
Telephone Number	:	787-951-1771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/20/2013

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