Provider Demographics
NPI:1881419299
Name:DETRES QUILES, VICTOR SHAMIR
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:SHAMIR
Last Name:DETRES QUILES
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:URB VALLE VERDE CALLE GLADYS RIOS # 11
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-903-2219
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 4055
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-4055
Practice Address - Country:US
Practice Address - Phone:787-658-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program