Healthcare Provider Details

I. General information

NPI: 1245434182
Provider Name (Legal Business Name): BENIGNO J. FERNANDEZ, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17720 CORPORATE WOODS DR
SAN ANTONIO TX
78259-3500
US

IV. Provider business mailing address

PO BOX 90415
SAN ANTONIO TX
78209-9084
US

V. Phone/Fax

Practice location:
  • Phone: 210-495-3627
  • Fax: 210-491-3581
Mailing address:
  • Phone: 210-495-3627
  • Fax: 210-491-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberJ0758
License Number StateTX

VIII. Authorized Official

Name: DR. BENIGNO J. FERNANDEZ
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 210-495-3627