Provider Demographics
NPI:1720163397
Name:QUINONES RODRIGUEZ, ANGEL M (M D)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
Last Name:QUINONES RODRIGUEZ
Suffix:
Gender:M
Credentials:M D
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 2714
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2714
Mailing Address - Country:US
Mailing Address - Phone:787-864-7093
Mailing Address - Fax:
Practice Address - Street 1:3 AVE LOS VETERANOS
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-6333
Practice Address - Country:US
Practice Address - Phone:787-864-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14621208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21371Medicare ID - Type UnspecifiedPROVIDER NUMBER