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General NPI Number Information
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NPI Number | 1598754897
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Entity Type | Individual
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Provider Name | MANUEL FERNANDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | AVE BALDORIOTY #67
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City | CAYEY
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State | PR
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Zip | 00736
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Country | US
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Telephone | 787-263-0702
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Fax | 787-738-5970
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Provider Business Mailing Address
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Address Line | PO BOX 372488
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City | CAYEY
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State | PR
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Zip | 00737-2488
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Country | US
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Telephone | 787-738-5611
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Fax | 787-738-5970
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5026
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License Number State | PR
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