Provider Demographics
NPI:1447255021
Name:LONGO, FERNANDO L (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:L
Last Name:LONGO
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:TORRE SAN PABLO SUITE 201
Mailing Address - Street 2:#68 CALLE SANTA CRUZ
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7038
Mailing Address - Country:US
Mailing Address - Phone:787-786-3358
Mailing Address - Fax:787-787-8183
Practice Address - Street 1:TORRE SAN PABLO SUITE 201
Practice Address - Street 2:#68 CALLE SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7038
Practice Address - Country:US
Practice Address - Phone:787-786-3358
Practice Address - Fax:787-787-8183
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3082207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE08253Medicare UPIN
PR0094753Medicare UPIN