1447930144 NPI number — GUSTAVO ENRIQUE QUINONES RIVERA

Table of content: GUSTAVO ENRIQUE QUINONES RIVERA (NPI 1447930144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447930144 NPI number — GUSTAVO ENRIQUE QUINONES RIVERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINONES RIVERA
Provider First Name:
GUSTAVO
Provider Middle Name:
ENRIQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1447930144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EUCALIPTO 275
Provider Second Line Business Mailing Address:
CIUDAD JARDIN 3
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-452-4232
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CIUDAD JARDIN 3
Provider Second Line Business Practice Location Address:
EUCALIPTO 275
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-452-4232
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2023

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: 103TC1900X , with the licence number:  7733 , 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)





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