Provider Demographics
NPI:1750320008
Name:RODRIGUEZ QUINONES, ANGEL LUIS SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:LUIS
Last Name:RODRIGUEZ QUINONES
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 192102
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2102
Mailing Address - Country:US
Mailing Address - Phone:787-764-6077
Mailing Address - Fax:787-758-0349
Practice Address - Street 1:33 CALLE MAYAGUEZ
Practice Address - Street 2:URB. PEREZ MORRIS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4917
Practice Address - Country:US
Practice Address - Phone:787-764-6077
Practice Address - Fax:787-758-0349
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028405OtherMEDICARE ID
PRD99586Medicare UPIN