Provider Demographics
NPI:1972531911
Name:OQUENDO, CARMEN VANESSA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:VANESSA
Last Name:OQUENDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEO DEL RIO #500
Mailing Address - Street 2:BLVD DEL RIO APT 5201
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-852-4343
Mailing Address - Fax:787-285-6559
Practice Address - Street 1:2 CALLE RAMON GOMEZ S
Practice Address - Street 2:URB. PEREYO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3925
Practice Address - Country:US
Practice Address - Phone:787-585-7095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15112208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-22203Medicare ID - Type Unspecified