Provider Demographics
NPI:1962518340
Name:FERNANDEZ, BEATRIZ HERCILIA (MD)
Entity type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:HERCILIA
Last Name:FERNANDEZ
Suffix:
Gender:F
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:FONT MARTELO AVENUE 301
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3204
Mailing Address - Country:US
Mailing Address - Phone:787-850-8985
Mailing Address - Fax:787-850-8985
Practice Address - Street 1:301 CALLE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3204
Practice Address - Country:US
Practice Address - Phone:787-850-8985
Practice Address - Fax:787-850-8985
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11482208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7910022OtherHUMANA INSURANCE
PR060632OtherCRUZ AZUL
PR3311482OtherUIA
PR1914OtherAMERICAN HEALTH
PR7046OtherFIRST MEDICAL
PR87773FEOtherTRIPLE S
PR2985OtherPAN AMERICAN
PRG42576Medicare UPIN
PR700002712Medicare ID - Type UnspecifiedTRIPLE S OPTIMO
PR87773FEOtherTRIPLE S
PR060632OtherCRUZ AZUL
PR0084301Medicare ID - Type Unspecified