Healthcare Provider Details

I. General information

NPI: 1336001908
Provider Name (Legal Business Name): ALEXIS FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 GRIFFIN RD
COOPER CITY FL
33328-3416
US

IV. Provider business mailing address

9778 NW 128TH LN
HIALEAH GARDENS FL
33018-7447
US

V. Phone/Fax

Practice location:
  • Phone: 954-689-0730
  • Fax: 888-725-9013
Mailing address:
  • Phone: 954-471-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: