Provider Demographics
NPI:1659472868
Name:QUILES, LESLIE ANN
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:QUILES
Suffix:
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:Q43 CALLE SANTA ROSA
Mailing Address - Street 2:URB. SANTA ELVIRA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3478
Mailing Address - Country:US
Mailing Address - Phone:787-761-0912
Mailing Address - Fax:
Practice Address - Street 1:Q43 CALLE SANTA ROSA
Practice Address - Street 2:URB. SANTA ELVIRA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3478
Practice Address - Country:US
Practice Address - Phone:787-761-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16477208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-5054Medicare ID - Type Unspecified
PRI-63409Medicare UPIN