Healthcare Provider Details

I. General information

NPI: 1831294271
Provider Name (Legal Business Name): ANGEL M NAVEDO FRONTERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COMERCIO 486
SAN ANTONIO PR
00690
US

IV. Provider business mailing address

PO BOX 785
SAN ANTONIO PR
00690
US

V. Phone/Fax

Practice location:
  • Phone: 787-890-3235
  • Fax: 787-890-5467
Mailing address:
  • Phone: 787-890-3235
  • Fax: 787-890-5467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5524
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: