Provider Demographics
NPI:1790817542
Name:QUINTANA BOSQUES, YELIZA (OT)
Entity Type:Individual
Prefix:
First Name:YELIZA
Middle Name:
Last Name:QUINTANA BOSQUES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360325
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0325
Mailing Address - Country:US
Mailing Address - Phone:787-244-1505
Mailing Address - Fax:787-735-0380
Practice Address - Street 1:1274 AVENIDA HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-244-1505
Practice Address - Fax:787-735-0380
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist