Provider Demographics
NPI:1073511432
Name:QUINTERO-HERENCIA, RICARDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:J
Last Name:QUINTERO-HERENCIA
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:PO BOX 2952
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-2952
Mailing Address - Country:US
Mailing Address - Phone:772-361-7642
Mailing Address - Fax:
Practice Address - Street 1:9800 BRIMHALL RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2783
Practice Address - Country:US
Practice Address - Phone:562-735-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2024-04-24
Deactivation Date:2005-09-29
Deactivation Code:
Reactivation Date:2006-11-01
Provider Licenses
StateLicense IDTaxonomies
VA0101282021207RX0202X
CAC161493207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1087226OtherWELLCARE
FL4468097OtherCONCENTRA/FOCUS THRU KEYS PHA
FL330467OtherAVMED
FLE7051SOtherMEDICARE
FL17336OtherBCBS
FL264422300Medicaid
FLP01462033OtherRAILROAD MEDICARE
FL4171740OtherCIGNA/GREAT WEST
FL7234314OtherAETNA
FLPRV0010410OtherPREFFERED MEDICAL PLAN
FL1087226OtherWELLCARE
FL17336OtherBCBS