Healthcare Provider Details

I. General information

NPI: 1720080930
Provider Name (Legal Business Name): GERARDO QUEVEDO-BONILLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CALLE SANTA CRUZ STE 204
BAYAMON PR
00961-6911
US

IV. Provider business mailing address

73 CALLE SANTA CRUZ STE 204
BAYAMON PR
00961-6911
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-9030
  • Fax: 787-786-1559
Mailing address:
  • Phone: 787-787-9030
  • Fax: 787-786-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7664
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: