Healthcare Provider Details

I. General information

NPI: 1144258583
Provider Name (Legal Business Name): LUIS CESAR FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NUNEZ ROMEU #51
CAYEY PR
00736
US

IV. Provider business mailing address

PO BOX 370868
CAYEY PR
00737-0868
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-4525
  • Fax: 787-738-4525
Mailing address:
  • Phone: 787-738-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4868
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: