Healthcare Provider Details

I. General information

NPI: 1942358015
Provider Name (Legal Business Name): RAFAEL F FERNANDEZ NBC- HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 WEST 12 ST SUITE 701
HIALEAH FL
33016
US

IV. Provider business mailing address

2191 SW 122 AVE. COURT
MIAMI FL
33175
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-4016
  • Fax: 305-480-0985
Mailing address:
  • Phone: 305-226-0661
  • Fax: 305-480-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS # 3095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: