Healthcare Provider Details

I. General information

NPI: 1023314614
Provider Name (Legal Business Name): JONATHAN FERNANDEZ PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 CALLE MARGINAL VILLAMAR
CAROLINA PR
00979-6345
US

IV. Provider business mailing address

1207 CALLE MARGINAL VILLAMAR
CAROLINA PR
00979-6345
US

V. Phone/Fax

Practice location:
  • Phone: 787-539-0404
  • Fax: 787-945-7128
Mailing address:
  • Phone: 787-539-0404
  • Fax: 787-945-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3872
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: