Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 7754 | PR |
NPI | 1164496014 |
---|---|
Provider Name | Dr. Felipe Fontanez Sullivan |
First Address | Guaynabo, PR 00966-1636 |
Second Address | Bayamon, PR 00959-7200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D-38355 | (02) | PR |