=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225047756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE ELIAS QUINTERO-NORIEGA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 12/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | E29 CALLE HERNANDEZ CARRION URB ATENAS
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00674-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-0740
-----------------------------------------------------
Fax | 787-854-8143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1934
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00674-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-0740
-----------------------------------------------------
Fax | 787-854-8143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 8766
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------