Healthcare Provider Details

I. General information

NPI: 1871834325
Provider Name (Legal Business Name): DINO RITCHIE FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 N ALAFAYA TRL STE 207
ORLANDO FL
32826-4754
US

IV. Provider business mailing address

3018 HYDRUS DR
ORLANDO FL
32828-9329
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-5313
  • Fax: 888-972-5443
Mailing address:
  • Phone: 407-579-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: