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General NPI Number Information
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NPI Number | 1164496014
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Entity Type | Individual
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Provider Name | FELIPE FONTANEZ SULLIVAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | BAYAMON MEDICAL PLZ SUITE 701
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City | BAYAMON
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State | PR
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Zip | 00959-7200
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Country | US
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Telephone | 787-798-5585
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Fax | 787-787-2101
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Provider Business Mailing Address
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Address Line | A40 CALLE 2 TINTILLO GARDENS
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City | GUAYNABO
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State | PR
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Zip | 00966-1636
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Country | US
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Telephone | 787-798-5500
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Fax | 787-787-2101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 7754
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License Number State | PR
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