Provider Demographics
NPI:1710936299
Name:QUINONES - RIVERA, RADAMES (MD)
Entity Type:Individual
Prefix:
First Name:RADAMES
Middle Name:
Last Name:QUINONES - RIVERA
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:HC 2 BOX 11347
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9608
Mailing Address - Country:US
Mailing Address - Phone:787-264-2178
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE MONSERRATE
Practice Address - Street 2:SUITE # 4
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-1707
Practice Address - Country:US
Practice Address - Phone:787-849-1833
Practice Address - Fax:787-849-0206
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40925Medicare UPIN