Healthcare Provider Details

I. General information

NPI: 1215940747
Provider Name (Legal Business Name): MARIA E. FERNANDEZ TAMAYO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ULTIMATE MEDICAL CENTER & SPA. LLC. 12700 SW 128TH STREET, SUITE 205
MIAMI FL
33186-5378
US

IV. Provider business mailing address

13500 SW 88TH ST STE 175
MIAMI FL
33186-1528
US

V. Phone/Fax

Practice location:
  • Phone: 305-278-7579
  • Fax: 305-278-7589
Mailing address:
  • Phone: 305-387-0081
  • Fax: 305-387-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME137016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: