Provider Demographics
NPI:1548378623
Name:FERNANDEZ ESTRADA, JACQUELINE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:FERNANDEZ ESTRADA
Suffix:
Gender:F
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 962
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0962
Mailing Address - Country:US
Mailing Address - Phone:787-851-0250
Mailing Address - Fax:787-851-0250
Practice Address - Street 1:CARR 14 KM 72.2
Practice Address - Street 2:BO RINCON SECTOR LOMAS
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-2800
Practice Address - Country:US
Practice Address - Phone:787-535-1001
Practice Address - Fax:787-535-1012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089470Medicare ID - Type Unspecified