Provider Demographics
NPI:1447930144
Name:QUINONES RIVERA, GUSTAVO ENRIQUE
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ENRIQUE
Last Name:QUINONES RIVERA
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:EUCALIPTO 275
Mailing Address - Street 2:CIUDAD JARDIN 3
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-452-4232
Mailing Address - Fax:
Practice Address - Street 1:CIUDAD JARDIN 3
Practice Address - Street 2:EUCALIPTO 275
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-452-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7733103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling