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General NPI Number Information
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NPI Number | 1720184385
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Entity Type | Organization
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Legal Business Name | DRA MADELINE FERNANDEZ GONZALEZ CSP
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 2431 BLVD LUIS A FERRE EDIFICIO PORRATA PILA STE 311
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City | PONCE
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State | PR
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Zip | 00717-2113
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Country | US
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Telephone | 787-843-0003
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Fax | 787-843-0003
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Provider Business Mailing Address
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Address Line | 2431 BLVD LUIS A FERRE EDIFICIO PORRATA PILA STE 311
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City | PONCE
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State | PR
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Zip | 00717-2113
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Country | US
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Telephone | 787-843-0003
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Fax | 787-841-1086
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MADELINE FERNANDEZ GONZALEZ
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Credential | MD
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Telephone | 787-843-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11858
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License Number State | PR
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