Provider Demographics
NPI:1942349428
Name:FERNANDEZ, CANDIDO (BSPH)
Entity Type:Individual
Prefix:MR
First Name:CANDIDO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 722 KM 7.3 BO ROBLES HAPPY PLAZA MALL
Mailing Address - Street 2:HC 02 BOX 15365
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-5200
Mailing Address - Fax:787-735-3359
Practice Address - Street 1:STREET 722 KM 7.3 BO ROBLES HAPPY PLAZA MALL
Practice Address - Street 2:HC 02 BOX 15365
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-5200
Practice Address - Fax:787-735-3359
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist