Provider Demographics
NPI:1336253269
Name:QUINONES, CESAR ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:ANTONIO
Last Name:QUINONES
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 1:400 AVE DOMENECH
Mailing Address - Street 2:SUITE 605
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3710
Mailing Address - Country:US
Mailing Address - Phone:787-764-8000
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH
Practice Address - Street 2:SUITE 605
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3710
Practice Address - Country:US
Practice Address - Phone:787-764-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2494207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR93165Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRE31108Medicare UPIN