MEDICARE: LOURDES FERNANDEZ

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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1184715609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES FERNANDEZ

Provider Business Mailing Address
First Line	:	11031 NE 6TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33161-7182
Country	:	US
Telephone Number	:	305-398-6100
Fax Number	:	305-757-4465

Provider Business Practice Location Address
First Line	:	5617 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3216
Country	:	US
Telephone Number	:	305-421-2260
Fax Number	:	305-421-2266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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Directions to “ LOURDES FERNANDEZ ” Practice Location

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