Healthcare Provider Details

I. General information

NPI: 1245814490
Provider Name (Legal Business Name): LIVIO HELVECIO FERNANDEZ III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 01/30/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR STE 601W
MIAMI FL
33176-2139
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-9777
  • Fax: 786-533-9518
Mailing address:
  • Phone: 786-594-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: