Healthcare Provider Details

I. General information

NPI: 1134324320
Provider Name (Legal Business Name): EILEEN MARTIZA QUINONES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 URB LAS DELICIAS
HORMIGUEROS PR
00660-1530
US

IV. Provider business mailing address

URB PORTA COELI ST 2 B 9 ST 2 B 9
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-2408
  • Fax:
Mailing address:
  • Phone: 787-892-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number10902
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: