1720101900 NPI number — DR. ROBERTO A. FERNANDEZ MD

Table of content: DR. ROBERTO A. FERNANDEZ MD (NPI 1720101900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720101900 NPI number — DR. ROBERTO A. FERNANDEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
ROBERTO
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1720101900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2885SW3RD AVE 300-400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33129-2324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-717-7509
Provider Business Mailing Address Fax Number:
786-717-7529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2885SW3RD AVE 300-400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33129-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-717-7509
Provider Business Practice Location Address Fax Number:
786-717-7529
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  16642 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ACN 259 , 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: ACN 259 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 16642 . This is a "MEDICAL DOCTOR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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