Provider Demographics
NPI:1821039165
Name:DIEZ-SIFONTES, ANTONIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:J
Last Name:DIEZ-SIFONTES
Suffix:
Gender:M
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 140038
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0038
Mailing Address - Country:US
Mailing Address - Phone:787-878-3306
Mailing Address - Fax:787-878-6232
Practice Address - Street 1:ARECIBO MEDICAL CENTER SUITE #209
Practice Address - Street 2:CARR. #2 , KM 80.0
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-878-3306
Practice Address - Fax:787-878-6232
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5680OtherSTATE LICENSE
PR5680OtherSTATE LICENSE
PR26462Medicare ID - Type Unspecified