Healthcare Provider Details

I. General information

NPI: 1164417150
Provider Name (Legal Business Name): MARIO E. QUINTERO - AGUILO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAS FLORES 60 ENS. MARTINEZ
MAYAGUEZ PR
00680-0000
US

IV. Provider business mailing address

PO BOX 294
MAYAGUEZ PR
00681-0294
US

V. Phone/Fax

Practice location:
  • Phone: 787-951-1771
  • Fax:
Mailing address:
  • Phone: 787-951-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number14807
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: