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General NPI Number Information
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NPI Number | 1003879503
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Entity Type | Individual
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Provider Name | ELIOT M FERNANDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 9140 CALLE MARINA OFICINA 601
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City | PONCE
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State | PR
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Zip | 00717-1592
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Country | US
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Telephone | 787-844-7105
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Fax | 787-840-2434
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Provider Business Mailing Address
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Address Line | 659 CALLE LADY DI URB LOS ALMENDROS
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City | PONCE
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State | PR
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Zip | 00716-3527
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Country | US
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Telephone | 787-840-1632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4139
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License Number State | PR
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