Healthcare Provider Details

I. General information

NPI: 1508477696
Provider Name (Legal Business Name): ANTONIO JOSE RODRIGUEZ QUINONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO DR. JOSE CELSO BARBOSA CENTRO MEDICO DE PUERTO RICO
SAN JUAN PR
00936
US

IV. Provider business mailing address

183 CALLE SANTA FE
GUAYANILLA PR
00656-1470
US

V. Phone/Fax

Practice location:
  • Phone: 939-629-7653
  • Fax:
Mailing address:
  • Phone: 939-629-7653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24490
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: