Healthcare Provider Details

I. General information

NPI: 1851960405
Provider Name (Legal Business Name): RAFAEL FERNANDEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13013 CORTEZ BLVD
BROOKSVILLE FL
34613-4838
US

IV. Provider business mailing address

13377 ELISE LN
SPRING HILL FL
34609-8960
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-9689
  • Fax:
Mailing address:
  • Phone: 352-442-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: