1639213861 NPI number — MISS IVETTE FONTANEZ I PSYCHOLOGIST

Table of content: MISS IVETTE FONTANEZ I PSYCHOLOGIST (NPI 1639213861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639213861 NPI number — MISS IVETTE FONTANEZ I PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTANEZ
Provider First Name:
IVETTE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
I
Provider Credential Text:
PSYCHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FONTANEZ
Provider Other First Name:
IVETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
PSYCHOLOGIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639213861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AA2 AVE TEJAS
Provider Second Line Business Mailing Address:
CORREO VILLA PMB 170
Provider Business Mailing Address City Name:
HUMACAO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00791-4351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-340-7493
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 CALLE DUFRESNE E
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-340-7493
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2462 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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