Provider Demographics
NPI:1023112430
Name:QUINONES RECIO, ROLANDO
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:QUINONES RECIO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ROLANDO
Other - Middle Name:
Other - Last Name:QUINONES RECIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:SANTA CECILIA STREET # 103
Mailing Address - Street 2:
Mailing Address - City:SANTUNCE
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-565-8697
Mailing Address - Fax:
Practice Address - Street 1:SANTA CECILIA STREET # 103
Practice Address - Street 2:
Practice Address - City:SANTUNCE
Practice Address - State:PR
Practice Address - Zip Code:00911
Practice Address - Country:US
Practice Address - Phone:787-565-8697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5118208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5118OtherLICENSE
PRA09623427OtherNONE
PRDM040170OtherNONE
PRA09623427OtherNONE
PR5118OtherLICENSE