Provider Demographics
NPI:1386227007
Name:FONTANEZ ALVAREZ, FREDDIE YAMIL
Entity Type:Individual
Prefix:
First Name:FREDDIE
Middle Name:YAMIL
Last Name:FONTANEZ ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BORINQUEN VALLEY
Mailing Address - Street 2:299 CALLE ARADO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9862
Mailing Address - Country:US
Mailing Address - Phone:787-214-5139
Mailing Address - Fax:
Practice Address - Street 1:BARRIO TOMAS DE CASTRO
Practice Address - Street 2:SECTOR EL CINCO CARR. 183 KM 4.8 LOCAL 1
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-214-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty