Healthcare Provider Details

I. General information

NPI: 1033479399
Provider Name (Legal Business Name): MR. JULIO FERNANDEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 LAKELAND HIGHLANDS RD
LAKELAND FL
33803-4338
US

IV. Provider business mailing address

3020 LAKELAND HIGHLANDS RD
LAKELAND FL
33803-4338
US

V. Phone/Fax

Practice location:
  • Phone: 863-686-3189
  • Fax: 863-682-1348
Mailing address:
  • Phone: 863-686-3189
  • Fax: 863-682-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License NumberAI140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: