Provider Demographics
NPI:1003879503
Name:FERNANDEZ, ELIOT M (MD)
Entity Type:Individual
Prefix:MR
First Name:ELIOT
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:659 CALLE LADY DI
Mailing Address - Street 2:URB LOS ALMENDROS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3527
Mailing Address - Country:US
Mailing Address - Phone:787-840-1632
Mailing Address - Fax:
Practice Address - Street 1:9140 CALLE MARINA
Practice Address - Street 2:OFICINA 601
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1592
Practice Address - Country:US
Practice Address - Phone:787-844-7105
Practice Address - Fax:787-840-2434
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4139208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDM033315OtherASSMCA
AF7199981OtherDEA
E31077Medicare UPIN