Provider Demographics
NPI:1194723262
Name:QUINTERO SERRANO, OSCAR R (MD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:R
Last Name:QUINTERO SERRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OSCAR
Other - Middle Name:R
Other - Last Name:QUINTERO SERRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:430 CALLE RUISENOR
Mailing Address - Street 2:CAMINOS DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2829
Mailing Address - Country:US
Mailing Address - Phone:787-844-6669
Mailing Address - Fax:787-844-6888
Practice Address - Street 1:450 CALLE FERROCARRIL
Practice Address - Street 2:SUITE 302 SANTA MARIA MEDICAL BUILDING
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1194
Practice Address - Country:US
Practice Address - Phone:787-844-6669
Practice Address - Fax:787-844-6888
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10601207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1194723262OtherNPI
PR83719Medicare PIN
PRG02811Medicare UPIN