Provider Demographics
NPI:1639286164
Name:OQUENDO NEGRON, IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:
Last Name:OQUENDO NEGRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRIS
Other - Middle Name:
Other - Last Name:OQUENDO NEGRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:URB LAS PALMAS DE CERRO GORDO
Mailing Address - Street 2:NUM 79 ST ARECA
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-484-2858
Mailing Address - Fax:787-262-1210
Practice Address - Street 1:URB LAS PALMAS DE CERRO GORDO
Practice Address - Street 2:NUM 79 ST ARECA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-594-1792
Practice Address - Fax:787-737-0244
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21487Medicare ID - Type Unspecified