Provider Demographics
NPI:1063866234
Name:FERNANDEZ, LUIS ENRIQUE
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:511 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1130
Mailing Address - Country:US
Mailing Address - Phone:908-768-9549
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 2 KM 39.50
Practice Address - Street 2:HOSPITAL WILMA N. VAZQUEZ
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00963
Practice Address - Country:US
Practice Address - Phone:787-858-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19469208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13786-IOtherJUNTA MEDICA DE PR