Healthcare Provider Details

I. General information

NPI: 1003879503
Provider Name (Legal Business Name): ELIOT M FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9140 CALLE MARINA OFICINA 601
PONCE PR
00717-1592
US

IV. Provider business mailing address

659 CALLE LADY DI URB LOS ALMENDROS
PONCE PR
00716-3527
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-7105
  • Fax: 787-840-2434
Mailing address:
  • Phone: 787-840-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4139
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: