Healthcare Provider Details

I. General information

NPI: 1073294146
Provider Name (Legal Business Name): FERNANDEZ MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 W 20TH AVE STE 224
HIALEAH FL
33016-1894
US

IV. Provider business mailing address

7600 W 20TH AVE STE 224
HIALEAH FL
33016-1894
US

V. Phone/Fax

Practice location:
  • Phone: 305-202-4655
  • Fax:
Mailing address:
  • Phone: 305-202-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE ESPINOSA VALDES
Title or Position: MGR
Credential:
Phone: 305-202-4655