Healthcare Provider Details

I. General information

NPI: 1851773303
Provider Name (Legal Business Name): JOSIE DANELLI FUENTES GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOULEVARD DR GUILLERMO ARBONA CENTRO MEDICO SAN JUAN
SAN JUAN PR
00935
US

IV. Provider business mailing address

BOULEVARD DR GUILLERMO ARBONA CENTRO MEDICO SAN JUAN
SAN JUAN PR
00935-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-6390
  • Fax:
Mailing address:
  • Phone: 787-753-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21049
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: