1619914595 NPI number — ELIZABETH NORIEGA DE QUINTERO MD

Table of content: ELIZABETH NORIEGA DE QUINTERO MD (NPI 1619914595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619914595 NPI number — ELIZABETH NORIEGA DE QUINTERO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORIEGA DE QUINTERO
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1619914595
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:
24 SANTA ANASTASIA ST
Provider Second Line Business Mailing Address:
URB ELVIGIA SAN
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-761-3114
Provider Business Mailing Address Fax Number:
787-854-8143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND EL CENTRO II OFIC 261MUNOZ RIVERA 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATO REY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-754-7198
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2006

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: 2084P0804X , with the licence number:  2102 , 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)

  • Identifier: 22357 . This is a "SSS" identifier . This identifiers is of the category "OTHER".




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