Provider Demographics
NPI:1841769528
Name:QUINONES, IVAN MANUEL (MS)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:MANUEL
Last Name:QUINONES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CALLE MONTENEGRO
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3633
Mailing Address - Country:US
Mailing Address - Phone:787-941-7878
Mailing Address - Fax:
Practice Address - Street 1:406 AVE ANDALUCIA STE 5
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4164
Practice Address - Country:US
Practice Address - Phone:939-439-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PR6265103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health