Healthcare Provider Details

I. General information

NPI: 1912013624
Provider Name (Legal Business Name): JOSE RUBEN FERNANDEZ BRITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 AVE GENERAL VALERO SUITE A
FAJARDO PR
00738-4843
US

IV. Provider business mailing address

311 AVE GENERAL VALERO
FAJARDO PR
00738-4843
US

V. Phone/Fax

Practice location:
  • Phone: 956-782-4002
  • Fax: 956-782-4004
Mailing address:
  • Phone: 787-655-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJ7954
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number007437
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: