MEDICARE: DR. JONATHAN FERNANDEZ PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3872	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3872	OTHER	PR	PSYCHOLOGY PUERTO RICO LICENCE

General Provider Information

NPI Number	:	1023314614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN FERNANDEZ PSY.D.

Provider Business Mailing Address
First Line	:	1207 CALLE MARGINAL VILLAMAR
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00979-6345
Country	:	US
Telephone Number	:	787-539-0404
Fax Number	:	787-945-7128

Provider Business Practice Location Address
First Line	:	1207 CALLE MARGINAL VILLAMAR
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00979-6345
Country	:	US
Telephone Number	:	787-539-0404
Fax Number	:	787-945-7128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	06/15/2026

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