1932383460 NPI number — ENRIQUE C FERNANDEZ MD PA

Table of content: (NPI 1932383460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932383460 NPI number — ENRIQUE C FERNANDEZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENRIQUE C 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:
1932383460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 558642
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:
33255-8642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-559-9732
Provider Business Mailing Address Fax Number:
786-427-1332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11760 BIRD RD
Provider Second Line Business Practice Location Address:
SUITE 741
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33175-3582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-559-9732
Provider Business Practice Location Address Fax Number:
786-427-1332
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
ENRIQUE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-559-9732

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME87802 , 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: 014600400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com