Healthcare Provider Details

I. General information

NPI: 1538366455
Provider Name (Legal Business Name): MAURO M FERNANDEZ-GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MAURO M FERNANDEZ-GONZALEZ M.D.

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL SAN CRISTOBAL, CARRETERA P.R. 506, KM. 1.0 EDIFICIO B, PRIMER PISO, SUITE 1
COTO LAUREL PR
00780
US

IV. Provider business mailing address

CALLE BIANCA, URB. TERRA SENORIAL #177
PONCE PR
00731
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-2121
  • Fax: 787-848-1110
Mailing address:
  • Phone: 612-206-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number018197
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number018197
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: