Provider Demographics
NPI:1487691093
Name:PUENTES, JUAN CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:PUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:
Other - Last Name:PUENTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1401 CALLE 40 SW
Mailing Address - Street 2:URB. LA RIVIERA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2535
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:787-777-3850
Practice Address - Street 1:ADMINISTRACION DE SERVICIOS MEDICOS DE PUERTO RICO -
Practice Address - Street 2:CENTRO MEDICO-RADIOLOGIA ( PISO 2). RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922-2129
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74-E390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program