Provider Demographics
NPI:1952616252
Name:OQUENDO-DE LOS SANTOS, QUETCY (MD)
Entity Type:Individual
Prefix:DR
First Name:QUETCY
Middle Name:
Last Name:OQUENDO-DE LOS SANTOS
Suffix:
Gender:F
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:A24 CALLE 1
Mailing Address - Street 2:VILLA COOPERATIVA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4203
Mailing Address - Country:US
Mailing Address - Phone:787-420-0161
Mailing Address - Fax:
Practice Address - Street 1:A24 CALLE 1
Practice Address - Street 2:VILLA COOPERATIVA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4203
Practice Address - Country:US
Practice Address - Phone:787-420-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17984208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice