Healthcare Provider Details

I. General information

NPI: 1043320021
Provider Name (Legal Business Name): RAYMOND IGLECIA - FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 HOOKS ST
CLERMONT FL
34711-3514
US

IV. Provider business mailing address

2440 HOOKS ST
CLERMONT FL
34711-3514
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0833
  • Fax: 523-394-0367
Mailing address:
  • Phone: 352-394-0833
  • Fax: 352-394-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101030060
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number0101030060
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: