Healthcare Provider Details

I. General information

NPI: 1851711105
Provider Name (Legal Business Name): JAVIER QUINONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CALLE J EXTENSION HERMANAS DAVILA
BAYAMON PR
00960
US

IV. Provider business mailing address

HC 06 BOX 13135
COROZAL PR
00783
US

V. Phone/Fax

Practice location:
  • Phone: 787-486-7682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1648
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: