MEDICARE: MR. ROMMEL QUINONES CO

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	363LP2300X	Primary Care Nurse Practitioner	4704197737	MI
2	363LA2200X	Adult Health Nurse Practitioner	002030	NV

General Provider Information

NPI Number	:	1548649924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROMMEL QUINONES CO

Provider Business Mailing Address
First Line	:	6255 SHARLANDS AVE
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-2882
Country	:	US
Telephone Number	:	775-770-7580
Fax Number	:

Provider Business Practice Location Address
First Line	:	6275 SHARLANDS AVE STE B15-18
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-3734
Country	:	US
Telephone Number	:	775-204-4000
Fax Number	:	775-204-4001

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	03/17/2021

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