Provider Demographics
NPI:1861604647
Name:FERNANDEZ, IVETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 1149
Mailing Address - Street 2:P.O. BOX 6400
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:787-312-8702
Mailing Address - Fax:
Practice Address - Street 1:CENTRO DE DETENCION DE SALINAS
Practice Address - Street 2:BO. SAN FELIPE
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-853-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical