Provider Demographics
NPI:1417995226
Name:FERNANDEZ SOSA, ISABEL R (MD)
Entity Type:Individual
Prefix:MS
First Name:ISABEL
Middle Name:R
Last Name:FERNANDEZ SOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:827 CALLE JOSE MARTI
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3311
Mailing Address - Country:US
Mailing Address - Phone:787-723-8787
Mailing Address - Fax:787-721-7175
Practice Address - Street 1:359 DE DIEGO AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1738
Practice Address - Country:US
Practice Address - Phone:787-721-7175
Practice Address - Fax:787-721-7175
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28906Medicare PIN
PRE04114Medicare UPIN