Healthcare Provider Details

I. General information

NPI: 1144400417
Provider Name (Legal Business Name): CARMEN I GARCIA FERNANDEZ PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 833 # KM12.4 BARRIO SANTA ROSA III
GUAYNABO PR
00969-3000
US

IV. Provider business mailing address

CARR 833 # KM12.4 BARRIO SANTA ROSA III
GUAYNABO PR
00969-3000
US

V. Phone/Fax

Practice location:
  • Phone: 787-790-6448
  • Fax: 787-790-6589
Mailing address:
  • Phone: 787-790-6448
  • Fax: 787-790-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number000511
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: