Provider Demographics
NPI:1972588952
Name:QUILES-LOPEZ, RICARDO LUIS (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:LUIS
Last Name:QUILES-LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CALLE JESUS M BENITEZ
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-2225
Mailing Address - Country:US
Mailing Address - Phone:787-375-1888
Mailing Address - Fax:787-991-1799
Practice Address - Street 1:BO. ASOMANTE CARR 723 INTERSECCION CARR 14 KM 0.1
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-375-1888
Practice Address - Fax:787-991-1799
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15232208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22579Medicare ID - Type Unspecified
PRI15142Medicare UPIN