Healthcare Provider Details

I. General information

NPI: 1639202682
Provider Name (Legal Business Name): DR. ANDRES FORTUNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ISLA VERDE COND LOS PINOS OESTE APT 10 - I
CAROLINA PR
00984-9046
US

IV. Provider business mailing address

PO BOX 79046
CAROLINA PR
00984-9046
US

V. Phone/Fax

Practice location:
  • Phone: 787-253-0684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number4223PR
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: