Provider Demographics
NPI:1174590897
Name:FERNANDEZ, CARLOS (MD)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364364
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4364
Mailing Address - Country:US
Mailing Address - Phone:787-783-3055
Mailing Address - Fax:787-200-8529
Practice Address - Street 1:ROAD 21, LAS LOMAS SUITE 011
Practice Address - Street 2:METROPOLITAN HOSPITAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-0921
Practice Address - Country:US
Practice Address - Phone:787-783-3055
Practice Address - Fax:787-200-8529
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3933207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79427Medicare UPIN
25177Medicare ID - Type Unspecified