Provider Demographics
NPI:1124486303
Name:OQUENDO, CARLOS JAVIER (MPT)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAVIER
Last Name:OQUENDO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CALLE BAEZ
Mailing Address - Street 2:URB. PEREZ MORRIS
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-767-6710
Mailing Address - Fax:
Practice Address - Street 1:500 CALLE BAEZ
Practice Address - Street 2:URB. PEREZ MORRIS
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-767-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist