Healthcare Provider Details

I. General information

NPI: 1699685453
Provider Name (Legal Business Name): WALFRIDO REINALDO FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 55TH AVENUE DR E
BRADENTON FL
34203-5514
US

IV. Provider business mailing address

4112 55TH AVENUE DR E
BRADENTON FL
34203-5514
US

V. Phone/Fax

Practice location:
  • Phone: 786-803-1019
  • Fax:
Mailing address:
  • Phone: 786-803-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberL24000449853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: