Healthcare Provider Details

I. General information

NPI: 1477564953
Provider Name (Legal Business Name): JUAN JOSE FERNANDEZ ADORNO PH.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 ITURREGUI PLAZA 217-A
SAN JUAN PR
00924
US

IV. Provider business mailing address

217 ITURREGUI PLAZA 217-A
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-5501
  • Fax: 787-768-8094
Mailing address:
  • Phone: 787-768-5501
  • Fax: 787-768-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1605
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: