Provider Demographics
NPI:1215032008
Name:FERNANDEZ, ILEANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CALLE SAN CLAUDIO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4222
Mailing Address - Country:US
Mailing Address - Phone:787-761-0888
Mailing Address - Fax:787-760-2195
Practice Address - Street 1:430 CALLE SAN CLAUDIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4222
Practice Address - Country:US
Practice Address - Phone:787-761-0888
Practice Address - Fax:787-760-2195
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660386268-02OtherMCS
PR660386268-02OtherMCS REFORMA
PR41527OtherSSS
PR4000164OtherHUMANA
PR041282OtherCRUZ AZUL
PR660386268OtherMAPFRE