Provider Demographics
NPI:1548211071
Name:FERNANDEZ ROSARIO, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:FERNANDEZ ROSARIO
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 1:1700 CALLE GERANIO
Mailing Address - Street 2:URB SAN FRANCISCO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6335
Mailing Address - Country:US
Mailing Address - Phone:787-767-1777
Mailing Address - Fax:787-751-0868
Practice Address - Street 1:708 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4502
Practice Address - Country:US
Practice Address - Phone:787-767-1777
Practice Address - Fax:787-751-0868
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3347207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0094203Medicare PIN
PRE33113Medicare UPIN