Healthcare Provider Details

I. General information

NPI: 1144635319
Provider Name (Legal Business Name): SAMUEL FERNANDEZ-PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 09/13/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARIMED PLAZA SUITE 403 B1 CALLE SANTA CRUZ
BAYAMON PR
00961-6933
US

IV. Provider business mailing address

CARIMED PLAZA SUITE 403 B1 CALLE SANTA CRUZ
BAYAMON PR
00961-6933
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-7070
  • Fax: 787-787-2107
Mailing address:
  • Phone: 787-798-7070
  • Fax: 787-787-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number21768
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number282723
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number21768
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: