Provider Demographics
NPI:1477929222
Name:QUINONES MORA, HEYDIMAR
Entity Type:Individual
Prefix:
First Name:HEYDIMAR
Middle Name:
Last Name:QUINONES MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GRAND PASEO BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6539
Mailing Address - Country:US
Mailing Address - Phone:787-283-2555
Mailing Address - Fax:787-283-2545
Practice Address - Street 1:CARR 172 CAGUAS A CIDRA
Practice Address - Street 2:URB. TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:FM
Practice Address - Zip Code:00725-0072
Practice Address - Country:US
Practice Address - Phone:787-653-0550
Practice Address - Fax:787-653-0538
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist