Healthcare Provider Details

I. General information

NPI: 1962450072
Provider Name (Legal Business Name): MARIA VICTORIA FERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 16TH AVE
HIALEAH FL
33012-4654
US

IV. Provider business mailing address

13173 SW 47TH ST
MIRAMAR FL
33027-3163
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-1600
  • Fax: 305-821-1632
Mailing address:
  • Phone: 305-336-6726
  • Fax: 305-821-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME61882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: