Provider Demographics
NPI:1851773303
Name:FUENTES GUTIERREZ, JOSIE DANELLI (MD)
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:DANELLI
Last Name:FUENTES GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOULEVARD DR GUILLERMO ARBONA CENTRO MEDICO
Mailing Address - Street 2:SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00935-5067
Mailing Address - Country:US
Mailing Address - Phone:787-753-6390
Mailing Address - Fax:
Practice Address - Street 1:BOULEVARD DR GUILLERMO ARBONA CENTRO MEDICO
Practice Address - Street 2:SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-753-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR21049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics