Provider Demographics
NPI:1568780443
Name:ACEVEDO-QUINONES, ENID H
Entity Type:Individual
Prefix:MRS
First Name:ENID
Middle Name:H
Last Name:ACEVEDO-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:PO BOX 1792
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-1792
Mailing Address - Country:US
Mailing Address - Phone:787-897-1636
Mailing Address - Fax:787-897-1636
Practice Address - Street 1:ROAD 111 KM 4.2
Practice Address - Street 2:BO LARES
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-1636
Practice Address - Fax:787-897-1636
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR892247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician