Basic Information
| Provider Information | |||||||||
| NPI: | 1548378623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ ESTRADA | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 962 | ||||||||
| Address2: | |||||||||
| City: | BOQUERON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006220962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878510250 | ||||||||
| FaxNumber: | 7878510250 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR 14 KM 72.2 | ||||||||
| Address2: | BO RINCON SECTOR LOMAS | ||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007372800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
| FaxNumber: | 7875351012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 10709 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.