Provider Demographics
NPI:1538168638
Name:QUINONES MEDINA, ERIC M SR
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:QUINONES MEDINA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 467 KM 1.0 INT
Mailing Address - Street 2:BO CAMASEYES
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-818-1255
Mailing Address - Fax:787-877-0350
Practice Address - Street 1:69 CALLE PEDRO SANTOS SUITE 7
Practice Address - Street 2:PLAZA REAL PROFESSIONAL BUILDING
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-1255
Practice Address - Fax:787-877-0350
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10400208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083241Medicare PIN
PRF94497Medicare UPIN
PR66-0578137Medicare PIN