Healthcare Provider Details

I. General information

NPI: 1275646044
Provider Name (Legal Business Name): JOSE L QUILICHINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 SANTA EDUVIGIS URB. SAGRADO CORAZON
SAN JUAN PR
00926
US

IV. Provider business mailing address

8340 NW 115TH CT
DORAL FL
33178-1958
US

V. Phone/Fax

Practice location:
  • Phone: 787-383-6162
  • Fax: 787-434-6214
Mailing address:
  • Phone: 787-383-6161
  • Fax: 305-884-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8778
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME108127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: