Healthcare Provider Details

I. General information

NPI: 1487577235
Provider Name (Legal Business Name): MR. CHRISTOPHER EMMANUEL FONTANEZ MATOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 172, URB. TURABO GARDENS
CAGUAS PR
00725
US

IV. Provider business mailing address

COND. MONTE MAYOR, 44 AVE. JUAN CARLOS DE BORBON APT. 1204, BOX 706
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-3038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: