Provider Demographics
NPI:1356355317
Name:FUENTES INGUANZO, JOSE J (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:J
Last Name:FUENTES INGUANZO
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 3102
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-3102
Mailing Address - Country:US
Mailing Address - Phone:787-817-1383
Mailing Address - Fax:787-817-4015
Practice Address - Street 1:531 AVE MIRAMAR
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-1383
Practice Address - Fax:787-817-4015
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7478207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29093Medicare ID - Type Unspecified