Healthcare Provider Details

I. General information

NPI: 1023272168
Provider Name (Legal Business Name): NELLA CRISTINA FERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 NORMANDIE DR
MONTGOMERY AL
36111-2732
US

IV. Provider business mailing address

225B WINTON M BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

V. Phone/Fax

Practice location:
  • Phone: 334-263-6228
  • Fax: 334-265-9136
Mailing address:
  • Phone: 334-263-6228
  • Fax: 334-263-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME125838
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMD.41696
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: