Provider Demographics
NPI:1104800630
Name:BERROCAL-FERNANDEZ, MARIA H (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:H
Last Name:BERROCAL-FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MHB OPHTHALMICS
Other - Middle Name:
Other - Last Name:PSC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 41281
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00940-1281
Mailing Address - Country:US
Mailing Address - Phone:787-725-9315
Mailing Address - Fax:787-724-4654
Practice Address - Street 1:150 AVE DE DIEGO
Practice Address - Street 2:SUITE 404
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-725-9315
Practice Address - Fax:787-724-4654
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9358207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42763Medicare UPIN
88884Medicare ID - Type Unspecified