Healthcare Provider Details

I. General information

NPI: 1821116229
Provider Name (Legal Business Name): HUGO S FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21110 BISCAYNE BLVD STE 203
AVENTURA FL
33180-1251
US

IV. Provider business mailing address

PO BOX 4189
DEERFIELD BEACH FL
33442-4189
US

V. Phone/Fax

Practice location:
  • Phone: 305-948-9595
  • Fax: 305-948-9292
Mailing address:
  • Phone: 954-363-9582
  • Fax: 954-363-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0054399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: