Provider Demographics
NPI:1649275603
Name:IGARTUA PONTON, JUAN M (MDFACC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:IGARTUA PONTON
Suffix:
Gender:M
Credentials:MDFACC
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:M
Other - Last Name:IGARTUA PONTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 CALLE SANTA CRUZ
Mailing Address - Street 2:INST SAN PABLO 401
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7049
Mailing Address - Country:US
Mailing Address - Phone:787-787-6083
Mailing Address - Fax:787-786-4987
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INST SAN PABLO 401
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7049
Practice Address - Country:US
Practice Address - Phone:787-787-6083
Practice Address - Fax:787-786-4987
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6069207RC0000X, 207RC0200X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78213Medicare UPIN