Healthcare Provider Details

I. General information

NPI: 1790056679
Provider Name (Legal Business Name): BEATRIZ FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NW 79TH AVE SUITE 501
DORAL FL
33166-6556
US

IV. Provider business mailing address

3900 NW 79TH AVE SUITE 501
DORAL FL
33166-6556
US

V. Phone/Fax

Practice location:
  • Phone: 305-597-3861
  • Fax: 305-597-3863
Mailing address:
  • Phone: 305-597-3861
  • Fax: 305-597-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT18063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: