Healthcare Provider Details

I. General information

NPI: 1922014109
Provider Name (Legal Business Name): JUAN ANTONIO RIOS FUENTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 15.7 TORRE MEDICA PEDRO BLANCO 1 SUITE 313
MANATI PR
00674
US

IV. Provider business mailing address

PMB 325 STATION 425 CARR 693
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-7979
  • Fax: 787-884-3033
Mailing address:
  • Phone: 787-854-7979
  • Fax: 787-884-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14033
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: