Provider Demographics
NPI:1346312246
Name:FERNANDEZ GONZALEZ, DAIANA (MD)
Entity Type:Individual
Prefix:
First Name:DAIANA
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:PO BOX 7301
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1203 AVE MUNOZ RIVERA
Practice Address - Street 2:VILLA MRILLASCA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0634
Practice Address - Country:US
Practice Address - Phone:787-843-4588
Practice Address - Fax:787-840-0907
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9545208000000X, 208D00000X
FL72131208000000X, 208D00000X
LA11087R208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
83042OtherTRIPLE S
3871OtherIMC
3648OtherPREFERRED HEALTH CHOICE
584041125OtherCOSVI
203741OtherPREFERRED HEALTH
3648OtherPREFERRED HEALTH CHOICE
83042OtherTRIPLE S