Provider Demographics
NPI:1568498657
Name:QUINONES BODEGA, CARLOS F (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:F
Last Name:QUINONES BODEGA
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 746
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0746
Mailing Address - Country:US
Mailing Address - Phone:787-969-1969
Mailing Address - Fax:787-851-2552
Practice Address - Street 1:CARR 100 KM 6.1 INT.
Practice Address - Street 2:BO MIRADERO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-969-1969
Practice Address - Fax:787-851-2552
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14734208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
H98824Medicare UPIN
21903Medicare ID - Type Unspecified