Provider Demographics
NPI:1023284759
Name:FERNANDEZ, PEDRO J (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:J
Last Name:FERNANDEZ
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:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0704
Mailing Address - Country:US
Mailing Address - Phone:787-834-2727
Mailing Address - Fax:787-834-2728
Practice Address - Street 1:EDIFICIO LA PALMA OFICINA 2 - E CALLE PERAL # 14
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-2727
Practice Address - Fax:787-834-2728
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR100672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88693Medicare PIN
PRG37218Medicare UPIN