MEDICARE: ROSA M FERNANDEZ D.M.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	1223P0700X	Prosthodontics	1831	PR

General Provider Information

NPI Number	:	1568669711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA M FERNANDEZ D.M.D.

Provider Business Mailing Address
First Line	:	560 AVE SAN LUIS
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-3640
Country	:	US
Telephone Number	:	787-878-4102
Fax Number	:	787-878-4107

Provider Business Practice Location Address
First Line	:	560 AVE SAN LUIS
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-3640
Country	:	US
Telephone Number	:	787-878-4102
Fax Number	:	787-878-4107

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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