Organization Name: | FAJARDO MEDICAL PRACTICE |
NPI Number: | 1134319320 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AGAPITO FONTANEZ NIEVES (PRESIDENTE) |
Mailing Address: | I23 Calle Principal Urb Baralt Fajardo |
State: | PR US |
Postal Code: | 007383772 |
Phone Number: | 7878637646 |
Fax Number: | 7878607357 |
NPI Enumeration Date: | 07/25/2007 |
NPI Last Update Date: | 07/25/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |