MEDICARE: NILVETTE ALEXANDRA BURGOS FONTAN

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	103TS0200X	School Psychologist	6183	PR

General Provider Information

NPI Number	:	1699632646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NILVETTE ALEXANDRA BURGOS FONTAN

Provider Business Mailing Address
First Line	:	6 CALLE ORQUIDEA URB RUSSE
Second Line	:
City	:	MOROVIS
State	:	PR
Zip	:	00687
Country	:	US
Telephone Number	:	787-308-5967
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR. 634 KM 1.0 INT. BO FRANQUEZ
Second Line	:
City	:	MOROVIS
State	:	PR
Zip	:	00687
Country	:	US
Telephone Number	:	787-308-5967
Fax Number	:

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

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “ NILVETTE ALEXANDRA BURGOS FONTAN ” Practice Location

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