Provider Demographics
NPI:1033231287
Name:ENTENZA, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:ENTENZA
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 1:368 VIA VERSALLES
Mailing Address - Street 2:VILLAS REALES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5339
Mailing Address - Country:US
Mailing Address - Phone:787-789-3241
Mailing Address - Fax:787-789-3241
Practice Address - Street 1:PLAZA LAUREL 300, LAUREL AVENUE
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:782-288-0277
Practice Address - Fax:787-966-7923
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR117642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087636Medicare ID - Type UnspecifiedPROVIDER, PSYCHIATRY