Healthcare Provider Details

I. General information

NPI: 1730532219
Provider Name (Legal Business Name): GABRIEL J. FUENTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 05/21/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JESUS T. PINEIRO BUILDING FERNANDEZ JUNCOS AVE BO. PUEBLO
CAROLINA PR
00979
US

IV. Provider business mailing address

PO BOX 3102
ARECIBO PR
00613-3102
US

V. Phone/Fax

Practice location:
  • Phone: 787-626-3322
  • Fax:
Mailing address:
  • Phone: 787-236-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number022209
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: