Provider Demographics
NPI:1912013624
Name:FERNANDEZ BRITO, JOSE RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RUBEN
Last Name:FERNANDEZ BRITO
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 1:311 AVE GENERAL VALERO
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4843
Mailing Address - Country:US
Mailing Address - Phone:787-655-2335
Mailing Address - Fax:
Practice Address - Street 1:311 AVE GENERAL VALERO
Practice Address - Street 2:SUITE A
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4843
Practice Address - Country:US
Practice Address - Phone:956-782-4002
Practice Address - Fax:956-782-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7954207V00000X
PR007437207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115831302Medicaid
TX00R53PMedicare ID - Type Unspecified
TX115831302Medicaid