Provider Demographics
NPI:1184056681
Name:OQUENDO, IRIS DAISY (MSW)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:DAISY
Last Name:OQUENDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 CALLE RUISENOR
Mailing Address - Street 2:MONTE VERDE
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9423
Mailing Address - Country:US
Mailing Address - Phone:787-368-9378
Mailing Address - Fax:
Practice Address - Street 1:CALLE RUISENOR 2128
Practice Address - Street 2:MONTE VERDE
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-368-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical