Healthcare Provider Details

I. General information

NPI: 1346731809
Provider Name (Legal Business Name): MR. MICHEL FERNANDEZ PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SW 37TH LN
CAPE CORAL FL
33914-7859
US

IV. Provider business mailing address

236 SW 37TH LN
CAPE CORAL FL
33914-7859
US

V. Phone/Fax

Practice location:
  • Phone: 754-244-3710
  • Fax:
Mailing address:
  • Phone: 754-244-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73232
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: