Healthcare Provider Details

I. General information

NPI: 1629058052
Provider Name (Legal Business Name): JEFFREY QUINONES MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA FUENTE TOWN CTR SUITE 11123
GUAYAMA PR
00784-6045
US

IV. Provider business mailing address

15 PARQ INTERAMERICANA
GUAYAMA PR
00784-7333
US

V. Phone/Fax

Practice location:
  • Phone: 787-866-1129
  • Fax:
Mailing address:
  • Phone: 787-864-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10485
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: