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General NPI Number Information
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NPI Number | 1578282919
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Entity Type | Individual
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Provider Name | ELIZ MARIE FUENTES PEREZ MD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | CARR 448 KM 2.0 INT SECT YEYO GONZALEZ BO GUAJATACA
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685
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Country | US
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Telephone | 939-438-5543
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Fax |
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Provider Business Mailing Address
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Address Line | HC 08 BOX 83531
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685
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Country | US
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Telephone | 939-438-5543
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 22960
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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 | 22960
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License Number State | PR
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