1740799683 NPI number — CLAUDIA FERNANDEZ MD PA

Table of content: (NPI 1740799683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740799683 NPI number — CLAUDIA FERNANDEZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAUDIA FERNANDEZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740799683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5630 SW 163RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHWEST RANCHES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33331-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 N UNIVERSITY DR STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-3617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-332-9400
Provider Business Practice Location Address Fax Number:
954-400-5479
Provider Enumeration Date:
09/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
347-579-5117

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X , with the licence number:  ME112453 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101554000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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