Provider Demographics
NPI:1376665190
Name:FERNANDEZ, JOAQUIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WINSTON CHURCHILL AVE.,
Mailing Address - Street 2:MSC 347
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6023
Mailing Address - Country:US
Mailing Address - Phone:787-999-6200
Mailing Address - Fax:787-999-6210
Practice Address - Street 1:138 AVE WINSTON CHURCHILL
Practice Address - Street 2:MSC 347
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6013
Practice Address - Country:US
Practice Address - Phone:787-999-6200
Practice Address - Fax:787-999-6210
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR9102207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE09026Medicare UPIN