Healthcare Provider Details

I. General information

NPI: 1619395209
Provider Name (Legal Business Name): RANDY QUINONES-MALDONADO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RANDY QUINONES PH.D

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

V. Phone/Fax

Practice location:
  • Phone: 787-310-3391
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5536
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: