Healthcare Provider Details

I. General information

NPI: 1205950920
Provider Name (Legal Business Name): CARLOS ALFONSO QUINTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL PEREA DR BASORA ST
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 1710
BOQUERON PR
00622-1710
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-0101
  • Fax:
Mailing address:
  • Phone: 787-438-6263
  • Fax: 787-834-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number13313
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: