Provider Demographics
NPI:1598843823
Name:FERNANDEZ, BENIGNO J (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:BENIGNO
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ELIZABETH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5935
Mailing Address - Country:US
Mailing Address - Phone:210-930-7565
Mailing Address - Fax:
Practice Address - Street 1:17720 CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-3500
Practice Address - Country:US
Practice Address - Phone:210-495-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0758273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1155525-01Medicaid
TXF33098Medicare UPIN
TX1155525-01Medicaid