Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 8499 | PR |
NPI | 1447225776 |
---|---|
Provider Name | Dr. Samuel A. Fernandez Lopez |
First Address | San Juan, PR 00926-7111 |
Second Address | Bayamon, PR 00961-6928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 21/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7310137 | HUMANA (01) | PR |
83628 | TRIPLE S (01) | PR |
E91277 | (02) | PR |