Healthcare Provider Details

I. General information

NPI: 1972157428
Provider Name (Legal Business Name): FERNANDEZ ORTHOFEET CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 16TH AVE SUITE 102
HIALEAH FL
33012
US

IV. Provider business mailing address

3750 W 16TH AVE SUITE 102
HIALEAH FL
33012
US

V. Phone/Fax

Practice location:
  • Phone: 786-254-7989
  • Fax: 305-640-5774
Mailing address:
  • Phone: 786-254-7989
  • Fax: 305-640-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DIAMELYS FERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-449-8559