Provider Demographics
NPI:1598317273
Name:SILVA CRESPO, FERNANDO
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:SILVA CRESPO
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:PO BOX 30270
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0270
Mailing Address - Country:US
Mailing Address - Phone:787-310-3012
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA PRADES
Practice Address - Street 2:843 CALLE CARMEN SANABRIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-450-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1811248172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver