Provider Demographics
NPI:1184194417
Name:FUSTER SOLIVAN, NATALIE JEANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:JEANETTE
Last Name:FUSTER SOLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2998
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2998
Mailing Address - Country:US
Mailing Address - Phone:787-238-4529
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL MENONITA GUAYAMA, AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:SUITE 203
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21158208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice