Healthcare Provider Details

I. General information

NPI: 1255325759
Provider Name (Legal Business Name): CID S QUINTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARDIOVASCULAR CENTER OF PR AND THE CARIBBEAN AMERICO MIRANDA AVE
SAN JUAN PR
00936-6258
US

IV. Provider business mailing address

PO BOX 363134
SAN JUAN PR
00936-3134
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-0122
  • Fax: 787-753-3596
Mailing address:
  • Phone: 787-281-0122
  • Fax: 787-753-3596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number10213
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: