Provider Demographics
NPI:1063752400
Name:EMPRESAS FONTANET GOMEZ INC.
Entity type:Organization
Organization Name:EMPRESAS FONTANET GOMEZ INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-549-1700
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0846
Mailing Address - Country:US
Mailing Address - Phone:787-549-1700
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MAGUEYES, ROAD 140, KILOMETER 63.4
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-846-4848
Practice Address - Fax:787-846-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy