Healthcare Provider Details

I. General information

NPI: 1972551653
Provider Name (Legal Business Name): WANDA QUINONES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 AVE HOSTOS
MAYAGUEZ PR
00680-1261
US

IV. Provider business mailing address

PO BOX 402
SAN GERMAN PR
00683-0402
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-8083
  • Fax:
Mailing address:
  • Phone: 787-210-7871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number230
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: