Healthcare Provider Details

I. General information

NPI: 1770570194
Provider Name (Legal Business Name): FERNANDO M DEL AMO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAROLINA SHOPP CTR DC 15
CAROLINA PR
00985-5672
US

IV. Provider business mailing address

CAROLINA SHOPP CTR DC 15
CAROLINA PR
00985-5672
US

V. Phone/Fax

Practice location:
  • Phone: 787-760-6604
  • Fax: 787-292-0130
Mailing address:
  • Phone: 787-760-6604
  • Fax: 787-292-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number16188
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: