Healthcare Provider Details

I. General information

NPI: 1679013437
Provider Name (Legal Business Name): JONATHAN ALEXANDER QUINONEZ D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12012 BOYETTE RD
RIVERVIEW FL
33569-5631
US

IV. Provider business mailing address

12012 BOYETTE RD
RIVERVIEW FL
33569-5631
US

V. Phone/Fax

Practice location:
  • Phone: 813-295-7762
  • Fax:
Mailing address:
  • Phone: 813-295-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS16342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS16342
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS16342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: