Healthcare Provider Details

I. General information

NPI: 1093730913
Provider Name (Legal Business Name): ALICIA E FERNANDEZ-GARCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 LASALLE LEFALL DR
QUINCY FL
32351-5278
US

IV. Provider business mailing address

178 LASALLE LEFALL DR
QUINCY FL
32351-5278
US

V. Phone/Fax

Practice location:
  • Phone: 850-875-3600
  • Fax: 850-627-7277
Mailing address:
  • Phone: 850-875-3600
  • Fax: 850-627-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0053193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: