MEDICARE: LYDIA R FERNANDEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	7023	PR

General Provider Information

NPI Number	:	1730143918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA R FERNANDEZ MD

Provider Business Mailing Address
First Line	:	C-64 DIAMANTE
Second Line	:	GOLDEN GATE CAPARRA
City	:	GUAYNABO
State	:	PR
Zip	:	00968
Country	:	US
Telephone Number	:	787-385-8088
Fax Number	:	787-296-2409

Provider Business Practice Location Address
First Line	:	HOSPITAL DE PSIQUIATRIA DR RAMON FERNANDEZ MARINA
Second Line	:	CALLE CASI BO MONACILLOS
City	:	SAN JUAN
State	:	PR
Zip	:	00922-2100
Country	:	US
Telephone Number	:	787-296-2409
Fax Number	:	787-296-2409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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