Healthcare Provider Details

I. General information

NPI: 1497659262
Provider Name (Legal Business Name): SOUTHWEST INTERNAL MEDICINE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CALLE FERROCARRIL
SAN GERMAN PR
00683-3952
US

IV. Provider business mailing address

26 CALLE FERROCARRIL
SAN GERMAN PR
00683-3952
US

V. Phone/Fax

Practice location:
  • Phone: 787-546-9408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SAMUEL FONTANET
Title or Position: PRESIDENT
Credential: MD
Phone: 787-546-9408