Provider Demographics
NPI:1891281945
Name:QUILES CORREA, DENISSE (MD)
Entity Type:Individual
Prefix:
First Name:DENISSE
Middle Name:
Last Name:QUILES CORREA
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:HC 2 BOX 6255
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-9203
Mailing Address - Country:US
Mailing Address - Phone:939-400-0934
Mailing Address - Fax:
Practice Address - Street 1:I23 CALLE ESMERALDA
Practice Address - Street 2:URBANIZACION LAS PRADERAS
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:939-400-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006111103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$Medicaid