Healthcare Provider Details

I. General information

NPI: 1093215139
Provider Name (Legal Business Name): DR. JOSE LUIS FENEQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 CALLE 62 SE
SAN JUAN PR
00921-2724
US

IV. Provider business mailing address

RR 2 BOX 2847
ANASCO PR
00610-9416
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 787-236-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number24376
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: