Provider Demographics
NPI:1164417150
Name:QUINTERO - AGUILO, MARIO E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:E
Last Name:QUINTERO - AGUILO
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 294
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0294
Mailing Address - Country:US
Mailing Address - Phone:787-951-1771
Mailing Address - Fax:
Practice Address - Street 1:LAS FLORES 60 ENS. MARTINEZ
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0000
Practice Address - Country:US
Practice Address - Phone:787-951-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14807207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660606085OtherSERVICIOS DE SALUD BELLA
PRPE4613OtherPAN AMERICAN
PR100041OtherCRUZ AZUL
PR5106085OtherUIA
PR660606085OtherMEDICAL CARD SYSTEMS
PR221055OtherPREFFERRED UTI
PR6800165OtherHUMANA INSURANCE
PR20170COtherPREFERRED MEDICARE CHOICE
PR22311OtherTRIPLE 2
PR6800165OtherHUMANA INSURANCE
PRI14578Medicare UPIN