Healthcare Provider Details

I. General information

NPI: 1619962446
Provider Name (Legal Business Name): JOSE RAMON FUENTES RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/30/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#8 C. LUZ CELENIA TIRADO
SAN GERMAN PR
00683
US

IV. Provider business mailing address

BOX 216 SECTOR ESPINOZA
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-529-5545
  • Fax:
Mailing address:
  • Phone: 787-529-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number6899
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: