Provider Demographics
NPI:1760912737
Name:BORRELL QUINONES, MANUEL DE JESUS (SA-C)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:DE JESUS
Last Name:BORRELL QUINONES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 JOHN STOCKBAUER DR APT 2201
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1963
Mailing Address - Country:US
Mailing Address - Phone:832-923-5611
Mailing Address - Fax:
Practice Address - Street 1:4109 JOHN STOCKBAUER DR APT 2201
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1963
Practice Address - Country:US
Practice Address - Phone:832-923-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17-272246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant