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General NPI Number Information
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NPI Number | 1366542821
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Entity Type | Individual
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Provider Name | JOSE L FERNANDEZ PEREYO DMD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | CALLE DOCTOR VIDAL ESQUINA ANTONIO LOPEZ
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City | HUMACAO
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State | PR
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Zip | 00792
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Country | US
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Telephone | 787-850-3450
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Fax | 787-850-3450
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Provider Business Mailing Address
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Address Line | PO BOX 427
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City | HUMACAO
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State | PR
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Zip | 00792-0427
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Country | US
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Telephone | 787-850-3450
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Fax | 787-850-3450
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 1458
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License Number State | PR
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