Provider Demographics
NPI:1356455000
Name:LUIS E. QUINONES, MD, PA
Entity Type:Organization
Organization Name:LUIS E. QUINONES, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-886-0361
Mailing Address - Street 1:12058 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 903
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1842
Mailing Address - Country:US
Mailing Address - Phone:904-886-0361
Mailing Address - Fax:904-886-0382
Practice Address - Street 1:12058 SAN JOSE BLVD
Practice Address - Street 2:SUITE 903
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1842
Practice Address - Country:US
Practice Address - Phone:904-886-0361
Practice Address - Fax:904-886-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME606082084P0800X
FLME 606082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF79125Medicare UPIN
FLK8999Medicare ID - Type UnspecifiedMEDICARE GROUP ID