Provider Demographics
NPI:1760057798
Name:DE JESUS QUINONES, IAN ANDRES
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:ANDRES
Last Name:DE JESUS QUINONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. CONDADO JAZMIN 115
Mailing Address - Street 2:CAGUAS
Mailing Address - City:PR
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-444-3699
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA BORINQUEN
Practice Address - Street 2:CALLE YUCAYEQUE, L-11
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0072
Practice Address - Country:US
Practice Address - Phone:787-444-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist