Provider Demographics
NPI:1881136000
Name:MQ MEDICAL PLAZA, INC.
Entity type:Organization
Organization Name:MQ MEDICAL PLAZA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE A
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:QUIRINDONGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-866-2235
Mailing Address - Street 1:PO BOX 1913
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1913
Mailing Address - Country:US
Mailing Address - Phone:787-866-2235
Mailing Address - Fax:787-686-6000
Practice Address - Street 1:1 CALLE 1 350
Practice Address - Street 2:URBANIZACION VILLA ROSA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-866-2235
Practice Address - Fax:787-686-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15195261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022593Medicaid
PRI 16798Medicare UPIN