Healthcare Provider Details

I. General information

NPI: 1720155708
Provider Name (Legal Business Name): QUINTIN GONZALEZ KEELAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BY PASS EDIFICIO PARRA SUITE 404
PONCE PR
00731
US

IV. Provider business mailing address

2225 PONCE BY PASS EDIFICIO PARRA SUITE 404
PONCE PR
00731
US

V. Phone/Fax

Practice location:
  • Phone: 787-290-0135
  • Fax: 787-284-5398
Mailing address:
  • Phone: 787-290-0135
  • Fax: 787-284-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number010331
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: