MEDICARE: DR. JOSE A. FUENTES JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	11381	PR

General Provider Information

NPI Number	:	1346228335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE A. FUENTES JR. M.D.

Provider Business Mailing Address
First Line	:	K6 PARQ DEL CONDADO
Second Line	:	BAIROA PARK
City	:	CAGUAS
State	:	PR
Zip	:	00727-1225
Country	:	US
Telephone Number	:	787-746-5431
Fax Number	:	787-745-1909

Provider Business Practice Location Address
First Line	:	26 CALLE JIMENEZ SICARDO
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-3737
Country	:	US
Telephone Number	:	787-745-1909
Fax Number	:	787-745-1909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	08/06/2015

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