Healthcare Provider Details

I. General information

NPI: 1972396422
Provider Name (Legal Business Name): BLUE HORIZON INTERVENTIONAL PULMONARY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 303
HIALEAH FL
33016-1812
US

IV. Provider business mailing address

7100 W 20TH AVE STE 303
HIALEAH FL
33016-1812
US

V. Phone/Fax

Practice location:
  • Phone: 305-335-0041
  • Fax:
Mailing address:
  • Phone: 305-335-0041
  • Fax: 305-489-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAUL FERNANDEZ
Title or Position: DO
Credential: DO
Phone: 305-335-0041