Provider Demographics
NPI:1225047756
Name:QUINTERO-NORIEGA, JOSE ELIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ELIAS
Last Name:QUINTERO-NORIEGA
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 1934
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1934
Mailing Address - Country:US
Mailing Address - Phone:787-854-0740
Mailing Address - Fax:787-854-8143
Practice Address - Street 1:E29 CALLE HERNANDEZ CARRION
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4622
Practice Address - Country:US
Practice Address - Phone:787-854-0740
Practice Address - Fax:787-854-8143
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
100005OtherMMM HEALTHCARE
PR80416OtherTRIPLE S HEALTH PLAN
PR80545Medicare PIN
PRD34280Medicare UPIN