Provider Demographics
NPI:1811956709
Name:FERNANDEZ, DAYRA (MD)
Entity type:Individual
Prefix:
First Name:DAYRA
Middle Name:
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 1:1028 AVE ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2904
Mailing Address - Country:US
Mailing Address - Phone:787-781-8316
Mailing Address - Fax:
Practice Address - Street 1:400 CALLE FERNANDO MONTILLA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2600
Practice Address - Country:US
Practice Address - Phone:787-765-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR118162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0089863Medicare ID - Type Unspecified
PRH67158Medicare UPIN