Provider Demographics
NPI:1174572242
Name:MEDINA QUINONES, CESAR H (MD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:H
Last Name:MEDINA QUINONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HCO3 BOX 17078 CARR 4491 RM 1-0
Mailing Address - Street 2:BARRIO PUENTE
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627
Mailing Address - Country:US
Mailing Address - Phone:787-820-4872
Mailing Address - Fax:787-898-4154
Practice Address - Street 1:ROAD 111 KM 1.9
Practice Address - Street 2:AVE LOS PARIOTAS
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-2727
Practice Address - Fax:787-897-2725
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11244208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
83461Medicare ID - Type Unspecified
G40402Medicare UPIN