Healthcare Provider Details

I. General information

NPI: 1619176880
Provider Name (Legal Business Name): KENEL FERNANDEZ BARBOSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INSTITUTO SAN PABLO STE 509 66 CALLE SANTA CRUZ
BAYAMON PR
00961-7041
US

IV. Provider business mailing address

PO BOX 6310 SANTA ROSA STATION
BAYAMON PR
00960-5310
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-4670
  • Fax:
Mailing address:
  • Phone: 787-269-4670
  • Fax: 787-269-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number7336
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KENEL FERNANDEZ BARBOSA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-269-4670