Provider Demographics
NPI:1992329239
Name:QUINONES VAZQUEZ, JOSE EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:EDWIN
Last Name:QUINONES VAZQUEZ
Suffix:
Gender:M
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:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0201
Mailing Address - Country:US
Mailing Address - Phone:939-281-2724
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA 718
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-0000
Practice Address - Country:US
Practice Address - Phone:787-836-4520
Practice Address - Fax:787-836-4520
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21731208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice