Healthcare Provider Details

I. General information

NPI: 1285738963
Provider Name (Legal Business Name): IVETTE CRESPO QUINONEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

R8 AVE SANTA JUANITA
BAYAMON PR
00956-4977
US

IV. Provider business mailing address

PO BOX 8120
BAYAMON PR
00960-8120
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-0977
  • Fax:
Mailing address:
  • Phone: 787-785-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10339
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: