Provider Demographics
NPI:1912065145
Name:QUESADA TORRES, CONSUELO ENID
Entity Type:Individual
Prefix:DR
First Name:CONSUELO
Middle Name:ENID
Last Name:QUESADA TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JOSE I. QUINTON
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-3037
Mailing Address - Country:US
Mailing Address - Phone:787-825-1771
Mailing Address - Fax:
Practice Address - Street 1:142 CALLE JOSE I QUINTON
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3037
Practice Address - Country:US
Practice Address - Phone:787-825-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14951208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH-98268Medicare UPIN