1073511432 NPI number — DR. RICARDO J. QUINTERO-HERENCIA M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073511432 NPI number — DR. RICARDO J. QUINTERO-HERENCIA M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

QUINTERO-HERENCIA

Provider First Name:

RICARDO

Provider Middle Name:

J.

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1073511432

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/24/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

09/29/2005

NPI Reactivation Date:

11/01/2006

Provider First Line Business Mailing Address:

PO BOX 2952

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MAYAGUEZ

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00681-2952

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

772-361-7642

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

9800 BRIMHALL RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BAKERSFIELD

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

93312-2783

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

562-735-3226

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/11/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RX0202X , with the licence number:  0101282021 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RH0003X , with the licence number: C161493 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1087226 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 4468097 . This is a "CONCENTRA/FOCUS THRU KEYS PHA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 330467 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: E7051S . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 17336 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 264422300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: P01462033 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 4171740 . This is a "CIGNA/GREAT WEST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 7234314 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: PRV0010410 . This is a "PREFFERED MEDICAL PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".