Provider Demographics
NPI:1538366455
Name:FERNANDEZ-GONZALEZ, MAURO M (MD)
Entity type:Individual
Prefix:
First Name:MAURO
Middle Name:M
Last Name:FERNANDEZ-GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAURO
Other - Middle Name:M
Other - Last Name:FERNANDEZ-GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:CALLE BIANCA, URB. TERRA SENORIAL
Mailing Address - Street 2:#177
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:612-206-2589
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL SAN CRISTOBAL, CARRETERA P.R. 506, KM. 1.0
Practice Address - Street 2:EDIFICIO B, PRIMER PISO, SUITE 1
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-848-2121
Practice Address - Fax:787-848-1110
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR018197207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine