Provider Demographics
NPI:1497195879
Name:VIEJO, FERNANDO (333)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:VIEJO
Suffix:
Gender:M
Credentials:333
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C MARTE 126 ATLANTIS VIEW
Mailing Address - Street 2:ISLA VERDE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-644-3889
Mailing Address - Fax:787-268-2787
Practice Address - Street 1:C MARTE 126 ATLANTIS VIEW
Practice Address - Street 2:ISLA VERDE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-0982
Practice Address - Country:US
Practice Address - Phone:787-644-3889
Practice Address - Fax:787-268-2787
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR333174M00000X
PR33174MM1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
No174MM1900XOther Service ProvidersVeterinarianMedical Research