Provider Demographics
NPI:1073614178
Name:FERNANDEZ MONTANEZ, AIDA LUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:LUZ
Last Name:FERNANDEZ MONTANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CALLE FARIS SANTIAGO
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-3019
Mailing Address - Country:US
Mailing Address - Phone:787-733-8161
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA BOULEVARD DEL RIO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-852-1400
Practice Address - Fax:787-852-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR93592083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine