Provider Demographics
NPI:1700175064
Name:FERNANDEZ, CAMALIE MARGARITA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMALIE
Middle Name:MARGARITA
Last Name:FERNANDEZ
Suffix:
Gender:F
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 6538
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6538
Mailing Address - Country:US
Mailing Address - Phone:787-644-3009
Mailing Address - Fax:
Practice Address - Street 1:C10 CALLE 16
Practice Address - Street 2:VILLA NUEVA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-6940
Practice Address - Country:US
Practice Address - Phone:787-644-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18088208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice