MEDICARE: ALEXIS VERA QUINONES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	16734	PR

General Provider Information

NPI Number	:	1083742381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS VERA QUINONES MD

Provider Business Mailing Address
First Line	:	PO BOX 6
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-0006
Country	:	US
Telephone Number	:	787-453-9886
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 CALLE PEDRO SANTOS
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-4015
Country	:	US
Telephone Number	:	787-453-9886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	01/06/2017

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