Healthcare Provider Details

I. General information

NPI: 1558856484
Provider Name (Legal Business Name): JORGE ARNALDO QUINTANA CARRERO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2018
Last Update Date: 06/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALLE TERESA JORNET
SAN JUAN PR
00926-7517
US

IV. Provider business mailing address

12 CALLE TERESA JORNET
SAN JUAN PR
00926-7517
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-1285
  • Fax:
Mailing address:
  • Phone: 787-777-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6573
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: