Basic Information
| Provider Information | |||||||||
| NPI: | 1548248164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINTOS | ||||||||
| FirstName: | JOSE BERNARDO | ||||||||
| MiddleName: | Q. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | HCH 122 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029031177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014446195 | ||||||||
| FaxNumber: | 4014446378 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HOPPIN ST | ||||||||
| Address2: | CORO WEST SUITE 200 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014445504 | ||||||||
| FaxNumber: | 4014442534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | MD12262 | RI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 12262 | 01 | RI | STATE LICENSE | OTHER | 1548248 | 05 | RI | MEDICAID |