Provider Demographics
NPI:1780824771
Name:QUINONES, WALESCA (MD)
Entity Type:Individual
Prefix:DR
First Name:WALESCA
Middle Name:
Last Name:QUINONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CALLE EL REY
Mailing Address - Street 2:UR EL REAL
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4121
Mailing Address - Country:US
Mailing Address - Phone:787-718-0844
Mailing Address - Fax:787-873-1074
Practice Address - Street 1:17 CALLE EL REY
Practice Address - Street 2:UR EL REAL
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4121
Practice Address - Country:US
Practice Address - Phone:787-718-0844
Practice Address - Fax:787-873-1074
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17485208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice