Healthcare Provider Details

I. General information

NPI: 1477908259
Provider Name (Legal Business Name): JAYSON O FUENTES-SOTO ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMM. BLONDET, CARR. NUM. 3, KM.139, BLOQUE K-26
GUAYAMA PR
00654
US

IV. Provider business mailing address

PO BOX 283
ARROYO PR
00714-0283
US

V. Phone/Fax

Practice location:
  • Phone: 787-628-2657
  • Fax:
Mailing address:
  • Phone: 787-375-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number041
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: