Healthcare Provider Details

I. General information

NPI: 1952616252
Provider Name (Legal Business Name): QUETCY OQUENDO-DE LOS SANTOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A24 CALLE 1 VILLA COOPERATIVA
CAROLINA PR
00985-4203
US

IV. Provider business mailing address

A24 CALLE 1 VILLA COOPERATIVA
CAROLINA PR
00985-4203
US

V. Phone/Fax

Practice location:
  • Phone: 787-420-0161
  • Fax:
Mailing address:
  • Phone: 787-420-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17984
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: