Provider Demographics
NPI:1942064712
Name:QUESADA, RAUL
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:QUESADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CALLE VICTORIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3767
Mailing Address - Country:US
Mailing Address - Phone:787-259-5233
Mailing Address - Fax:787-842-4671
Practice Address - Street 1:40 MUNOZ RIVERA ST
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-3030
Practice Address - Fax:787-845-5428
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist