Provider Demographics
NPI:1114768256
Name:QUINONES, LETICIA X
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:QUINONES
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12192 SAINT LUCIA
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6563
Mailing Address - Country:US
Mailing Address - Phone:915-253-6297
Mailing Address - Fax:
Practice Address - Street 1:6519 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2112
Practice Address - Country:US
Practice Address - Phone:915-253-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home