Healthcare Provider Details

I. General information

NPI: 1043648736
Provider Name (Legal Business Name): ROBERTO FERNANDEZ D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

10741 SW 102ND AVE
MIAMI FL
33176-3513
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-4400
  • Fax:
Mailing address:
  • Phone: 305-799-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS13013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberUO2923
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0S13013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: