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NPI Code Detail

MEDICARE: DR. FERNANDO ALFREDO GINEBRA SIRI MD

MEDICARE: DR. FERNANDO ALFREDO GINEBRA SIRI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics PhysicianME167521FL

General Provider Information

NPI Number : 1023690864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FERNANDO ALFREDO GINEBRA SIRI MD
Provider Business Mailing Address
First Line : 295 JOHNSTON AVE APT 429
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07304-4320
Country : US
Telephone Number : 929-216-3387
Fax Number :
Provider Business Practice Location Address
First Line : 596 COURTLAND BLVD
Second Line :
City : DELTONA
State : FL
Zip : 32738-8902
Country : US
Telephone Number : 407-249-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2021
Last Update Date : 07/21/2024

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