MEDICARE: JUSTO QUINONES NEGRON 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	208000000X	Pediatrics Physician	12212	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7290	OTHER	PR	IMC
2	89942	OTHER	PR	TRIPLE S
3	060858	OTHER	PR	CRUZ AZUL
4	7933087	OTHER	PR	CIGNA

General Provider Information

NPI Number	:	1346208782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTO QUINONES NEGRON MD

Provider Business Mailing Address
First Line	:	196 CALLE VIOLETA
Second Line	:	LOIZA VALLEY
City	:	CANOVANAS
State	:	PR
Zip	:	00729-3572
Country	:	US
Telephone Number	:	787-256-7742
Fax Number	:	787-256-7742

Provider Business Practice Location Address
First Line	:	975 CALLE BAUHINIA
Second Line	:	LOIZA VALLEY
City	:	CANOVANAS
State	:	PR
Zip	:	00729-3410
Country	:	US
Telephone Number	:	787-256-7742
Fax Number	:	787-256-7742

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/24/2013

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