Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15191 | PR |
NPI | 1013079193 |
---|---|
Provider Name | Dr. Luis A Quinones |
First Address | Ponce, PR 00728 |
Second Address | Ponce, PR 00728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15191 | MEDICAL LICENSE (01) | PR |