Provider Demographics
NPI:1528809381
Name:FERNANDEZ, PEDRO LUIS (BA, SOCIAL WORKER)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:LUIS
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:BA, SOCIAL WORKER
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 9368
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9368
Mailing Address - Country:US
Mailing Address - Phone:939-413-7515
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA # 653, BO. CORCOVADA
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-880-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15564104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker