Provider Demographics
NPI:1376596171
Name:DR JA FONTANILLAS CSP
Entity Type:Organization
Organization Name:DR JA FONTANILLAS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ARNOLDO
Authorized Official - Last Name:FONTANILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-895-4052
Mailing Address - Street 1:PO BOX 1456
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1456
Mailing Address - Country:US
Mailing Address - Phone:787-895-4052
Mailing Address - Fax:787-895-1188
Practice Address - Street 1:CAR #2 KM 96.7
Practice Address - Street 2:BO COCOS, 2ND FLOOR FARMACIA GLORIANA
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-4052
Practice Address - Fax:787-895-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8663208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty