=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619831427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUENTES MEDICAL CENTER CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2025
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 AVE PONCE DE LEON
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-3619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-515-5592
-----------------------------------------------------
Fax | 786-515-5592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 483 CALLE TERUEL
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00923-2721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-515-5592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARIAGNA FUENTES LOPEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-515-5592
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------