Provider Demographics
NPI:1487213260
Name:DE JESUS QUINONES, WILMAR (PHL)
Entity Type:Individual
Prefix:MISS
First Name:WILMAR
Middle Name:
Last Name:DE JESUS QUINONES
Suffix:
Gender:F
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 AVE NORFE APTO3404
Mailing Address - Street 2:VISTAS DE MONTECASINO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-234-2767
Mailing Address - Fax:
Practice Address - Street 1:500 AVE NORFE APTO3404
Practice Address - Street 2:VISTAS DE MONTECASINO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3582
Practice Address - Country:US
Practice Address - Phone:787-234-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR620207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2587501OtherTRIPLE SSS, HUMANA, MCS