Healthcare Provider Details

I. General information

NPI: 1346312246
Provider Name (Legal Business Name): DAIANA FERNANDEZ GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 AVE MUNOZ RIVERA VILLA MRILLASCA
PONCE PR
00717-0634
US

IV. Provider business mailing address

PO BOX 7301
PONCE PR
00732-7301
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-4588
  • Fax: 787-840-0907
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9545
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72131
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11087R
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9545
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number72131
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11087R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: