Healthcare Provider Details

I. General information

NPI: 1578087250
Provider Name (Legal Business Name): EMANUEL MEJIAS LAFONTAINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DE VETERANOS
PONCE PR
00716
US

IV. Provider business mailing address

1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

V. Phone/Fax

Practice location:
  • Phone: 787-415-1142
  • Fax:
Mailing address:
  • Phone: 787-843-2750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number33394
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22747
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: