Healthcare Provider Details

I. General information

NPI: 1164496014
Provider Name (Legal Business Name): FELIPE FONTANEZ SULLIVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL PLZ SUITE 701
BAYAMON PR
00959-7200
US

IV. Provider business mailing address

A40 CALLE 2 TINTILLO GARDENS
GUAYNABO PR
00966-1636
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-5585
  • Fax: 787-787-2101
Mailing address:
  • Phone: 787-798-5500
  • Fax: 787-787-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number7754
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: