Healthcare Provider Details

I. General information

NPI: 1992818637
Provider Name (Legal Business Name): WILLIAM FRED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOPEZ SANCHES #100
GURABO PR
00778
US

IV. Provider business mailing address

PMB 708 AVE RAFAEL CORDERO 200STE 140
CAGUAS PR
00725-3757
US

V. Phone/Fax

Practice location:
  • Phone: 787-712-4444
  • Fax:
Mailing address:
  • Phone: 787-746-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14519
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: