Provider Demographics
NPI:1386929149
Name:LUQUE FONTANEZ, CESAR (MD)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:
Last Name:LUQUE FONTANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23318
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-3318
Mailing Address - Country:US
Mailing Address - Phone:787-299-8835
Mailing Address - Fax:
Practice Address - Street 1:29 WASHINGTON STREET, AVENUE 1451
Practice Address - Street 2:ASHFORD MEDICAL CENTER, OFFICE 805
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-721-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19298208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery