Basic Information
| Provider Information | |||||||||
| NPI: | 1831117191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ-PEREZ | ||||||||
| FirstName: | ENRIQUE | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 AVE JESUS T PINERO | ||||||||
| Address2: | COND HATO REY PLZ APT 20-B | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009184109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877678771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 CALLE CASIA | ||||||||
| Address2: | ONE VETERANS PLZ | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009213200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876417582 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5841 | PR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.