Provider Demographics
NPI:1609133206
Name:FERNANDEZ LOPEZ ORTHOPEDIC SERVICES PSC
Entity Type:Organization
Organization Name:FERNANDEZ LOPEZ ORTHOPEDIC SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-661-0368
Mailing Address - Street 1:MONTEHIEDRA
Mailing Address - Street 2:200 ZORZAL ST.
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-661-0368
Mailing Address - Fax:787-790-6408
Practice Address - Street 1:CARIMED PLZ
Practice Address - Street 2:B1 SANTA CRUZ ST.
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8499207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty