Healthcare Provider Details

I. General information

NPI: 1760432355
Provider Name (Legal Business Name): LAURA ISIS FERNANDEZ-ORTIZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 NE 2ND AVE
MIAMI SHORES FL
33138-2310
US

IV. Provider business mailing address

9715 NE 2ND AVE
MIAMI SHORES FL
33138-2310
US

V. Phone/Fax

Practice location:
  • Phone: 305-757-8040
  • Fax: 305-757-8011
Mailing address:
  • Phone: 305-757-8040
  • Fax: 305-757-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME82129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: