Provider Demographics
NPI:1144635319
Name:FERNANDEZ-PEREZ, SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:FERNANDEZ-PEREZ
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:CARIMED PLAZA SUITE 403
Mailing Address - Street 2:B1 CALLE SANTA CRUZ
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6933
Mailing Address - Country:US
Mailing Address - Phone:787-798-7070
Mailing Address - Fax:787-787-2107
Practice Address - Street 1:CARIMED PLAZA SUITE 403
Practice Address - Street 2:B1 CALLE SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6933
Practice Address - Country:US
Practice Address - Phone:787-798-7070
Practice Address - Fax:787-787-2107
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21768207X00000X, 207XS0114X
MA282723207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program