Healthcare Provider Details

I. General information

NPI: 1508477696
Provider Name (Legal Business Name): ANTONIO JOSE RODRIGUEZ QUINONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 CALLE SANTA FE
GUAYANILLA PR
00656-1470
US

IV. Provider business mailing address

183 CALLE SANTA FE
GUAYANILLA PR
00656-1470
US

V. Phone/Fax

Practice location:
  • Phone: 939-629-7653
  • Fax:
Mailing address:
  • Phone: 939-629-7653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24490
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: