Provider Demographics
NPI:1053325787
Name:QUINONEZ, ARACELIS LOPEZ (RD)
Entity Type:Individual
Prefix:MISS
First Name:ARACELIS
Middle Name:LOPEZ
Last Name:QUINONEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CALLE JOSE P H HERNANDEZ
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2931
Mailing Address - Country:US
Mailing Address - Phone:787-550-7783
Mailing Address - Fax:787-734-4129
Practice Address - Street 1:1454 MADISON AVE W
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2200
Practice Address - Country:US
Practice Address - Phone:239-658-3000
Practice Address - Fax:239-658-3199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7870133V00000X
PR1293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJF512ZOtherMEDICARE ID