Provider Demographics
NPI:1962694547
Name:QUIMIO AMBULATORIA DR. JOSE A. MARQUES BIBILONI
Entity type:Organization
Organization Name:QUIMIO AMBULATORIA DR. JOSE A. MARQUES BIBILONI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MARQUES
Authorized Official - Last Name:BIBILONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-728-2479
Mailing Address - Street 1:PO BOX 19798
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1798
Mailing Address - Country:US
Mailing Address - Phone:787-728-2479
Mailing Address - Fax:787-726-7447
Practice Address - Street 1:655 MANUEL PAVIA FERNANDEZ
Practice Address - Street 2:EDIFICIO CHINEA CUARTO PISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-728-2479
Practice Address - Fax:787-726-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10042302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40291Medicare UPIN