Provider Demographics
NPI:1205969615
Name:QUINTERO, JOSUE
Entity type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:
Last Name:QUINTERO
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:P.O. BOX
Mailing Address - Street 2:1880
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-730-8666
Mailing Address - Fax:787-777-1577
Practice Address - Street 1:CARRETERA 65 KL 3 SHOPING TUNEL CARCARE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:939-891-9911
Practice Address - Fax:787-777-1577
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2022-05-25
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2014-10-08
Provider Licenses
StateLicense IDTaxonomies
3416S0300X
PRTC-AMB-7173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR55484Medicare ID - Type UnspecifiedAMBULANCE SERVICE