Provider Demographics
NPI:1861709842
Name:QUINONES CRUZ, MAYTE (LND)
Entity type:Individual
Prefix:
First Name:MAYTE
Middle Name:
Last Name:QUINONES CRUZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE PERLA DEL SUR H 24
Mailing Address - Street 2:REPARTO FLAMINGO
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00959
Mailing Address - Country:UM
Mailing Address - Phone:787-447-7204
Mailing Address - Fax:
Practice Address - Street 1:CALLE PERLA DEL SUR H 24
Practice Address - Street 2:REPARTO FLAMINGO
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00959
Practice Address - Country:UM
Practice Address - Phone:787-447-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-11
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1462133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education