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General NPI Number Information
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NPI Number | 1477655611
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Entity Type | Individual
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Provider Name | MANUELA A FONSECA RIVERA
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Gender | Female
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CALLE GEORGETTI #122 AMBULATORY MEDICAL SERVICES
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City | RIO PIEDRAS
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State | PR
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Zip | 00925
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Country | US
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Telephone | 787-758-1718
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Fax | 787-758-1718
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Provider Business Mailing Address
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Address Line | URB PACIFICA P6 121 VIA ARCOIRIS ENCANTADA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-755-8786
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Fax | 787-758-1718
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | BF2810871
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | DM097915
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License Number State | PR
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