Individual
JUSTIN RAFAEL OVALLES DE LA FUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 PATERSON ST STE 7300, NEW BRUNSWICK, NJ 08901-1962
(732) 235-8887
Mailing address
125 PATERSON ST STE 7300, NEW BRUNSWICK, NJ 08901-1962
(732) 235-8887
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA12154500
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2021
Last updated
06/12/2024
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