Provider Demographics
NPI:1487792271
Name:DR. PEDRO J FERNANDEZ CSP
Entity type:Organization
Organization Name:DR. PEDRO J FERNANDEZ CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-2727
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0704
Mailing Address - Country:US
Mailing Address - Phone:787-834-2727
Mailing Address - Fax:787-834-2728
Practice Address - Street 1:CALLE DE DIEGO #55-E CPR PROFESSIONAL BUILDING
Practice Address - Street 2:SUITE 301
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-2727
Practice Address - Fax:787-834-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10067261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health