Healthcare Provider Details

I. General information

NPI: 1518962406
Provider Name (Legal Business Name): JOSE JAVIER MUNIZ-QUINONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE DR BASORA N SUITE 212
MAYAGUEZ PR
00680-4810
US

IV. Provider business mailing address

PO BOX 3224
MAYAGUEZ PR
00681-3224
US

V. Phone/Fax

Practice location:
  • Phone: 787-805-5830
  • Fax: 787-805-6430
Mailing address:
  • Phone: 787-805-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number10620
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: