Basic Information
| Provider Information | |||||||||
| NPI: | 1164496014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FONTANEZ SULLIVAN | ||||||||
| FirstName: | FELIPE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | A40 CALLE 2 | ||||||||
| Address2: | TINTILLO GARDENS | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009661636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877985500 | ||||||||
| FaxNumber: | 7877872101 | ||||||||
| Practice Location | |||||||||
| Address1: | BAYAMON MEDICAL PLZ | ||||||||
| Address2: | SUITE 701 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009597200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877985585 | ||||||||
| FaxNumber: | 7877872101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 03/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 7754 | PR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.