Provider Demographics
NPI:1306876867
Name:FERNANDEZ SIFRE, CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:FERNANDEZ SIFRE
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 1:400 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 408 CLINICA LAS AMERICAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-751-8739
Mailing Address - Fax:787-751-8739
Practice Address - Street 1:400 ROOSEVELT AVE.
Practice Address - Street 2:SUITE 408 CLINICA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-8739
Practice Address - Fax:787-751-8739
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9-9385Medicare ID - Type UnspecifiedMEDICARE ID NUMBER