Healthcare Provider Details

I. General information

NPI: 1619831427
Provider Name (Legal Business Name): FUENTES MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 AVE PONCE DE LEON
SAN JUAN PR
00918-3619
US

IV. Provider business mailing address

483 CALLE TERUEL
SAN JUAN PR
00923-2721
US

V. Phone/Fax

Practice location:
  • Phone: 786-515-5592
  • Fax: 786-515-5592
Mailing address:
  • Phone: 786-515-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ARIAGNA FUENTES LOPEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-515-5592