Provider Demographics
NPI:1447225776
Name:FERNANDEZ LOPEZ, SAMUEL A
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:A
Last Name:FERNANDEZ LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CALLE ZORZAL
Mailing Address - Street 2:URB. MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7111
Mailing Address - Country:US
Mailing Address - Phone:787-798-7070
Mailing Address - Fax:787-787-2107
Practice Address - Street 1:CARIMED PLZ
Practice Address - Street 2:B-1 CALLE SANTA CRUZ SUITE 403-404
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6928
Practice Address - Country:US
Practice Address - Phone:787-798-7070
Practice Address - Fax:787-787-2107
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8499207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83628OtherTRIPLE S
PR7310137OtherHUMANA
PRE91277Medicare UPIN
PR7310137OtherHUMANA