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General NPI Number Information
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NPI Number | 1538248406
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Entity Type | Individual
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Provider Name | WILDA M FERNANDEZ MSW
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | BRAU 46B ST. SUITE 1
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City | CABO ROJO
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State | PR
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Zip | 00623-0684
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Country | US
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Telephone | 787-613-5719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1311
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City | BOQUERON
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State | PR
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Zip | 00622-1311
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Country | US
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Telephone | 787-851-6016
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Fax | 787-851-6016
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6749
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License Number State | PR
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