Provider Demographics
NPI:1053334201
Name:QUINONES-CORDERO, ERIC A (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:QUINONES-CORDERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 AVE HOSTOS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3235
Mailing Address - Country:US
Mailing Address - Phone:787-767-1095
Mailing Address - Fax:787-767-0910
Practice Address - Street 1:513 AVE HOSTOS
Practice Address - Street 2:STE 3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3235
Practice Address - Country:US
Practice Address - Phone:787-767-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR601678OtherMEDICARE Y MUCHO MAS
PR89607OtherTRIPLE S INC
PR310721OtherMEDICAL CARD SYSTEM
PR30205OtherPROSSAM
PR9180391OtherHUMANA
PR060950OtherCRUZ AZUL
PR30205OtherPROSSAM
PR89607OtherTRIPLE S INC