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General NPI Number Information
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NPI Number | 1255403010
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Entity Type | Individual
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Provider Name | CARLOS AGAPITO FONTANEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | AVE OSVALDO MOLINA #151 SUITE 103
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City | FAJARDO
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State | PR
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Zip | 00738-3614
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Country | US
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Telephone | 787-801-0081
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | PUERTO REAL
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State | PR
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Zip | 00740-0458
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Country | US
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Telephone |
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 16110
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License Number State | PR
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