Basic Information
| Provider Information | |||||||||
| NPI: | 1407191679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDEZ FONTAN | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | CARIMED PLAZA B1 SUITE 406 | ||||||||
| Address2: | CALLE SANTA CRUZ | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009610001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877796896 | ||||||||
| FaxNumber: | 7877796805 | ||||||||
| Practice Location | |||||||||
| Address1: | CARIMED PLAZA B1 SUITE 406 | ||||||||
| Address2: | CALLE SANTA CRUZ | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009610001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877796896 | ||||||||
| FaxNumber: | 7877796805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2012 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 888 | PR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.