=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538284393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OFICINA MEDICA DR QUINTERO PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 04/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 CALLE FERROCARRIL SUITE 302 SANTA MARIA MEDICAL BLDG
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-6669
-----------------------------------------------------
Fax | 787-844-6888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB 194 1575 AVENIDA MUNOZ RIVERA URB MARIANI
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-844-7027
-----------------------------------------------------
Fax | 787-844-6888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CARDIOLOGIST
-----------------------------------------------------
Name | DR. OSCAR R QUINTERO SERRANO
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 787-844-6669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 10601
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------