Provider Demographics
NPI:1285898502
Name:CENTRO GERIATRICO DEL ESTE PSC
Entity type:Organization
Organization Name:CENTRO GERIATRICO DEL ESTE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FONTANEZ, MD
Authorized Official - Suffix:SR
Authorized Official - Credentials:16110
Authorized Official - Phone:787-340-4125
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:PUERTO REAL
Mailing Address - State:PR
Mailing Address - Zip Code:00740-0458
Mailing Address - Country:US
Mailing Address - Phone:787-801-0081
Mailing Address - Fax:
Practice Address - Street 1:151 AVE OSVALDO MOLINA
Practice Address - Street 2:SUITE 103
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4013
Practice Address - Country:US
Practice Address - Phone:787-801-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5177207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty