Provider Demographics
NPI:1548644016
Name:QUINONES, JEAN CARLO
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:CARLO
Last Name:QUINONES
Suffix:
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 1:7005 PASEO LA FORTUNA
Mailing Address - Street 2:HACIENDAS DEL MONTE
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2305
Mailing Address - Country:US
Mailing Address - Phone:787-375-3027
Mailing Address - Fax:
Practice Address - Street 1:AVE 65 INFANTERIA
Practice Address - Street 2:HOSPITAL DR. FRANCISCO TRILLA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-7627
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR802086292390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program