Healthcare Provider Details

I. General information

NPI: 1750625471
Provider Name (Legal Business Name): LINO B. FERNANDEZ, MD & ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 CORAL WAY STE 601
CORAL GABLES FL
33145-2601
US

IV. Provider business mailing address

414 BARBAROSSA AVE
CORAL GABLES FL
33146-3504
US

V. Phone/Fax

Practice location:
  • Phone: 305-967-8144
  • Fax: 305-967-8368
Mailing address:
  • Phone: 305-661-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME39453
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME39453
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME39453
License Number StateFL

VIII. Authorized Official

Name: LINO B FERNANDEZ
Title or Position: OWNER
Credential: MD
Phone: 305-322-4564