Healthcare Provider Details

I. General information

NPI: 1659461101
Provider Name (Legal Business Name): INTI FERNANDEZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9804 SW 40TH ST
MIAMI FL
33165-3912
US

IV. Provider business mailing address

PO BOX 347768
CORAL GABLES FL
33234-7768
US

V. Phone/Fax

Practice location:
  • Phone: 305-222-9199
  • Fax: 305-222-9155
Mailing address:
  • Phone: 305-903-7142
  • Fax: 305-512-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 97323
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME97323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: