Healthcare Provider Details

I. General information

NPI: 1467199687
Provider Name (Legal Business Name): LEDIER R. FERNANDEZ - SERRANO CBHCMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5287 DELTONA BLVD
SPRING HILL FL
34606-1204
US

IV. Provider business mailing address

3416 W 84TH ST STE 108
HIALEAH FL
33018-4935
US

V. Phone/Fax

Practice location:
  • Phone: 813-750-6582
  • Fax: 786-442-2176
Mailing address:
  • Phone: 813-750-6582
  • Fax: 786-442-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: