Healthcare Provider Details

I. General information

NPI: 1891706404
Provider Name (Legal Business Name): HECTOR O FONTANET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G07 CAMPO RICO AVE COUNTRY CLUB
CAROLINA PR
00982-2678
US

IV. Provider business mailing address

I 25 VIA LLANURAS LA VISTA
SAN JUAN PR
00924-4480
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-4079
  • Fax: 787-762-9110
Mailing address:
  • Phone: 787-768-8814
  • Fax: 787-768-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2059
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: