1275646044 NPI number — DR. JOSE L QUILICHINI M.D.

Table of content: DR. JOSE L QUILICHINI M.D. (NPI 1275646044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275646044 NPI number — DR. JOSE L QUILICHINI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUILICHINI
Provider First Name:
JOSE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1275646044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8340 NW 115TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-1958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-383-6161
Provider Business Mailing Address Fax Number:
305-884-7719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1629 SANTA EDUVIGIS
Provider Second Line Business Practice Location Address:
URB. SAGRADO CORAZON
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-383-6162
Provider Business Practice Location Address Fax Number:
787-434-6214
Provider Enumeration Date:
08/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  8778 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: ME108127 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FK604A . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".