Provider Demographics
NPI:1043316607
Name:FERNANDEZ GONZALEZ, MADELINE (MD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:FERNANDEZ GONZALEZ
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:EDIF A PORRATA PILA
Mailing Address - Street 2:2431 BLVD LUIS A FERRE STE 311
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2116
Mailing Address - Country:US
Mailing Address - Phone:787-843-0003
Mailing Address - Fax:787-843-0003
Practice Address - Street 1:EDIF A PORRATA PILA
Practice Address - Street 2:2431 BLVD LUIS A FERRE STE 311
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2116
Practice Address - Country:US
Practice Address - Phone:787-843-0003
Practice Address - Fax:787-841-1086
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG90632Medicare UPIN
PR0089957Medicare ID - Type Unspecified