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General NPI Number Information
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NPI Number | 1578503116
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Entity Type | Individual
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Provider Name | FARES A CID MANSUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | CALLE ACACIA EDIFICIO MICHELLE PLAZA SECTOR VILLA FLORE SUITE 106
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City | PONCE
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State | PR
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Zip | 00716-0000
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Country | US
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Telephone | 787-812-1210
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Fax | 787-812-1211
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Provider Business Mailing Address
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Address Line | PMB 383609 AVE TITO CASTRO SUITE 102
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City | PONCE
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State | PR
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Zip | 00716-0000
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Country | US
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Telephone | 787-812-1210
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Fax | 787-812-1211
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 10164
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License Number State | PR
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