Provider Demographics
NPI:1407191679
Name:FERNANDEZ FONTAN, MARIA M (RPT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:FERNANDEZ FONTAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARIMED PLAZA B1 SUITE 406
Mailing Address - Street 2:CALLE SANTA CRUZ
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-0001
Mailing Address - Country:US
Mailing Address - Phone:787-779-6896
Mailing Address - Fax:787-779-6805
Practice Address - Street 1:CARIMED PLAZA B1 SUITE 406
Practice Address - Street 2:CALLE SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-0001
Practice Address - Country:US
Practice Address - Phone:787-779-6896
Practice Address - Fax:787-779-6805
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist