Provider Demographics
NPI:1851582712
Name:FERNANDEZ, JENARO ALBERTO (DC)
Entity Type:Individual
Prefix:
First Name:JENARO
Middle Name:ALBERTO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DC
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 825
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0825
Mailing Address - Country:US
Mailing Address - Phone:787-677-1839
Mailing Address - Fax:
Practice Address - Street 1:21 CALLE EMILIO RUIZ
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2202
Practice Address - Country:US
Practice Address - Phone:787-280-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor