Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4139 | PR |
NPI | 1003879503 |
---|---|
Provider Name | Mr. Eliot M Fernandez |
First Address | Ponce, PR 00716-3527 |
Second Address | Ponce, PR 00717-1592 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AF7199981 | DEA (01) | |
DM033315 | ASSMCA (01) | PR |
E31077 | (02) |