Healthcare Provider Details

I. General information

NPI: 1114258258
Provider Name (Legal Business Name): CENTRO DE GINECOLOGIA Y OBSTETRICIA DR. CARLOS A. FONSECA SALGADO, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 CALLE PROF AUGUSTO RODRIGUEZ COND. ASIA, SUITE 401
SAN JUAN PR
00909-2275
US

IV. Provider business mailing address

148 CALLE ALELI URB. SAN FRANCISCO
SAN JUAN PR
00927-6303
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-9995
  • Fax:
Mailing address:
  • Phone: 787-998-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number16371
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number16371
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS A FONSECA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-998-9995