Provider Demographics
NPI:1437100930
Name:ABREU GONZALEZ, FERNANDO
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:ABREU GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 36 BOX 36
Mailing Address - Street 2:URB MONTE ATENAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-300-1175
Mailing Address - Fax:787-723-1736
Practice Address - Street 1:1300 CALLE ATENAS # URB
Practice Address - Street 2:RR 36 BOX 36
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7807
Practice Address - Country:US
Practice Address - Phone:787-300-1175
Practice Address - Fax:787-723-1736
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46957Medicare UPIN
23055Medicare ID - Type Unspecified