Provider Demographics
NPI:1942755400
Name:QUINONES RIVERA, JOEL A (LND)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:QUINONES RIVERA
Suffix:
Gender:M
Credentials:LND
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 1240
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1240
Mailing Address - Country:US
Mailing Address - Phone:787-236-2480
Mailing Address - Fax:
Practice Address - Street 1:76 CALLE COLON
Practice Address - Street 2:CARR 115 KM 24.3
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3114
Practice Address - Country:US
Practice Address - Phone:787-252-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1649133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist