1619195419 NPI number — MISS MARIELY QUINONES RPT

Table of content: MISS MARIELY QUINONES RPT (NPI 1619195419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619195419 NPI number — MISS MARIELY QUINONES RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINONES
Provider First Name:
MARIELY
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANTIAGO
Provider Other First Name:
QUINONES
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RHT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1619195419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 539 PO BOX 7105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-7105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-842-2285
Provider Business Mailing Address Fax Number:
787-844-0983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
367 CALLE VICTORIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00730-3473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-842-2285
Provider Business Practice Location Address Fax Number:
787-844-0983
Provider Enumeration Date:
04/24/2007

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: 183700000X , with the licence number:  5783 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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