Provider Demographics
NPI:1508438904
Name:CONCEPCION QUINONES, NELITZA M
Entity Type:Individual
Prefix:
First Name:NELITZA
Middle Name:M
Last Name:CONCEPCION QUINONES
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 1:2 CALLE A1
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5124
Mailing Address - Country:US
Mailing Address - Phone:787-904-2743
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO COMERCIAL LOCAL 1
Practice Address - Street 2:URB. CATALANA #66
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-0061
Practice Address - Country:US
Practice Address - Phone:787-915-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11602355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4678414OtherDRIVERS LICENSE