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General NPI Number Information
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NPI Number | 1386227007
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Entity Type | Individual
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Provider Name | FREDDIE YAMIL FONTANEZ ALVAREZ
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Gender | Male
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | BARRIO TOMAS DE CASTRO SECTOR EL CINCO CARR. 183 KM 4.8 LOCAL 1
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-214-5139
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Fax |
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Provider Business Mailing Address
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Address Line | URB BORINQUEN VALLEY 299 CALLE ARADO
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City | CAGUAS
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State | PR
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Zip | 00725-9862
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Country | US
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Telephone | 787-214-5139
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 865
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License Number State | PR
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