Provider Demographics
NPI:1932255353
Name:QUINONES, EVARISTO (MD)
Entity Type:Individual
Prefix:DR
First Name:EVARISTO
Middle Name:
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:HC 58 BOX 14748
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9726
Mailing Address - Country:US
Mailing Address - Phone:787-868-4378
Mailing Address - Fax:787-868-4378
Practice Address - Street 1:CARR 417 KM 0.2 AVE NATIVO ALERS
Practice Address - Street 2:OFFICE #1
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9726
Practice Address - Country:US
Practice Address - Phone:787-868-4378
Practice Address - Fax:787-868-4378
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082695Medicare ID - Type UnspecifiedMEDICARE PROVIDER #