Healthcare Provider Details

I. General information

NPI: 1639189541
Provider Name (Legal Business Name): MIGUEL A. QUINONES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

137 PASEO ESMERALDA URB. PASEO SANTA BARBARA
GURABO PR
00778-5132
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-594-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number20862
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: