Provider Demographics
NPI:1811150782
Name:FERNANDEZ JUNCOS MEDICAL CLINIC
Entity type:Organization
Organization Name:FERNANDEZ JUNCOS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIGRID
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAMIREZ VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-407-8307
Mailing Address - Street 1:381 AVE FELISA R DE GAUTIER
Mailing Address - Street 2:COND PASEO MONTE APT 407
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6661
Mailing Address - Country:US
Mailing Address - Phone:787-407-8307
Mailing Address - Fax:
Practice Address - Street 1:381 AVE FELISA R DE GAUTIER
Practice Address - Street 2:COND PASEO MONTE APT 407
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-407-8307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15197208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty