Healthcare Provider Details

I. General information

NPI: 1649530478
Provider Name (Legal Business Name): BERTA TERESITA FERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2012
Last Update Date: 05/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 NW 34TH ST
MIAMI FL
33127-3344
US

IV. Provider business mailing address

730 NW 34TH ST
MIAMI FL
33127-3344
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-1335
  • Fax: 305-635-2859
Mailing address:
  • Phone: 305-635-1335
  • Fax: 305-635-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 86873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: