Individual provider Active NPI

Liz Quevedo, BACH

  • Specialist
  • San Juan, PR
National Provider Identifier
1962606608
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
188 Issued in PR
Practice address
1324 Calle Canada
Ave. de Diego
San Juan, PR 00920-3860
Phone
(787) 783-0750
Fax
(787) 781-8129
NPI assigned
Jun 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 188 PR Primary

Addresses

Primary practice location

1324 Calle Canada
Ave. de Diego
San Juan, PR 00920-3860

Mailing address

I6 Calle Rio Bairoa
Rio Hondo
Bayamon, PR 00961-3439
Phone (787) 778-4561

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
188PRMDSpecialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962606608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "I6 CALLE RIO BAIROA",
            "address_2": "RIO HONDO",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009613439",
            "telephone_number": "787-778-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 CALLE CANADA",
            "address_2": "AVE. DE DIEGO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009203860",
            "telephone_number": "787-783-0750",
            "fax_number": "787-781-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEVEDO",
        "first_name": "LIZ",
        "name_prefix": "Mrs.",
        "credential": "BACH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PR",
            "license": "188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.