Healthcare Provider Details

I. General information

NPI: 1639286164
Provider Name (Legal Business Name): IRIS OQUENDO NEGRON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRIS OQUENDO NEGRON MD

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB LAS PALMAS DE CERRO GORDO NUM 79 ST ARECA
VEGA ALTA PR
00692
US

IV. Provider business mailing address

URB LAS PALMAS DE CERRO GORDO NUM 79 ST ARECA
VEGA ALTA PR
00692
US

V. Phone/Fax

Practice location:
  • Phone: 787-594-1792
  • Fax: 787-737-0244
Mailing address:
  • Phone: 787-484-2858
  • Fax: 787-262-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14196
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: