Healthcare Provider Details

I. General information

NPI: 1235068776
Provider Name (Legal Business Name): DANIEL JOSUE FONTANEZ-IRIZARRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

T10 CALLE LAUREL VALLE ARRIBA HTS.
CAROLINA PR
00983
US

IV. Provider business mailing address

T10 CALLE LAUREL VALLE ARRIBA HTS.
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-223-5103
  • Fax:
Mailing address:
  • Phone: 787-223-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6783676
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: