1053368985 NPI number — DR. ANSELMO FUENTES-APONTE MD

Table of content: DR. ANSELMO FUENTES-APONTE MD (NPI 1053368985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053368985 NPI number — DR. ANSELMO FUENTES-APONTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUENTES-APONTE
Provider First Name:
ANSELMO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053368985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2765 AVE DOS PALMAS STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949-4136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-784-5000
Provider Business Mailing Address Fax Number:
866-296-9467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2765 AVE DOS PALMAS STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949-4136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-784-5000
Provider Business Practice Location Address Fax Number:
866-296-9467
Provider Enumeration Date:
05/27/2006

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: 171100000X , with the licence number:  261 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 9033 , 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)

  • Identifier: 500419E . This is a "MMM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81262 . This is a "TRIPLE S" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9500015 . This is a "HUMANA INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29033 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9033 . This is a "LICENCIA MEDICO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 067358 . This is a "CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3567 . This is a "PREFERRED MEDICARE CHOICE (PMC)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: HB25P09033 HIFP . This is a "HUMANA HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PE2379 . This is a "PALIC" identifier . This identifiers is of the category "OTHER".




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