Healthcare Provider Details

I. General information

NPI: 1922130574
Provider Name (Legal Business Name): JOSE L QUINTERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALLE SIRACUSA URB.VILLA CAPRI
SAN JUAN PR
00924-4000
US

IV. Provider business mailing address

12 CALLE SIRACUSA URB.VILLA CAPRI
SAN JUAN PR
00924-4000
US

V. Phone/Fax

Practice location:
  • Phone: 787-376-1709
  • Fax:
Mailing address:
  • Phone: 787-376-1709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number5799
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: