Healthcare Provider Details

I. General information

NPI: 1932168630
Provider Name (Legal Business Name): SANDRA M FERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CALLE RAMON E BETANCES HOSPITAL SAN ANTONIO 1ST FLOOR
MAYAGUEZ PR
00680-1729
US

IV. Provider business mailing address

PO BOX 11913
SAN JUAN PR
00922-1913
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-0111
  • Fax: 787-834-6850
Mailing address:
  • Phone: 787-999-0753
  • Fax: 787-841-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12004
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12004
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: