Healthcare Provider Details

I. General information

NPI: 1174590897
Provider Name (Legal Business Name): CARLOS FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 21, LAS LOMAS SUITE 011 METROPOLITAN HOSPITAL
SAN JUAN PR
00921-0921
US

IV. Provider business mailing address

PO BOX 364364
SAN JUAN PR
00936-4364
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-3055
  • Fax: 787-200-8529
Mailing address:
  • Phone: 787-783-3055
  • Fax: 787-200-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number3933
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: