Provider Demographics
NPI:1124181185
Name:FERNANDEZ ROSA, CARLOS A (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:FERNANDEZ ROSA
Suffix:
Gender:M
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:PO BOX 14247
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00916-4247
Mailing Address - Country:US
Mailing Address - Phone:787-728-7965
Mailing Address - Fax:787-726-2369
Practice Address - Street 1:AVE BORINQUEN #2263
Practice Address - Street 2:SUITE #2 ALTOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915
Practice Address - Country:US
Practice Address - Phone:787-728-7965
Practice Address - Fax:787-726-2369
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5499208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E43281Medicare UPIN
26390Medicare ID - Type Unspecified