Provider Demographics
NPI:1003185190
Name:QUINONES, MYRNA I (RD/LD)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:I
Last Name:QUINONES
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:I
Other - Last Name:ALVIRA RIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 CALLE MARINA
Mailing Address - Street 2:MANS. PLAYA HUCARES
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-2875
Mailing Address - Country:US
Mailing Address - Phone:580-695-0339
Mailing Address - Fax:787-874-4292
Practice Address - Street 1:125 CALLE MARINA
Practice Address - Street 2:MANS. PLAYA HUCARES
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-2875
Practice Address - Country:US
Practice Address - Phone:580-354-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL801376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered