Healthcare Provider Details

I. General information

NPI: 1376665190
Provider Name (Legal Business Name): JOAQUIN FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 AVE WINSTON CHURCHILL MSC 347
SAN JUAN PR
00926-6013
US

IV. Provider business mailing address

138 WINSTON CHURCHILL AVE., MSC 347
SAN JUAN PR
00926-6023
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-6200
  • Fax: 787-999-6210
Mailing address:
  • Phone: 787-999-6200
  • Fax: 787-999-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number9102
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: