Provider Demographics
NPI:1104792415
Name:QUINONES, WILDA Y
Entity type:Individual
Prefix:
First Name:WILDA
Middle Name:Y
Last Name:QUINONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WILDA
Other - Middle Name:YOMARY
Other - Last Name:QUINONES CLEMENTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39R CARR 190
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-7430
Mailing Address - Country:US
Mailing Address - Phone:787-200-0567
Mailing Address - Fax:
Practice Address - Street 1:CALLE JULIAN BENGOCHEA
Practice Address - Street 2:#1232 SAN MARTIN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-200-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1046224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant