Healthcare Provider Details

I. General information

NPI: 1184584096
Provider Name (Legal Business Name): NATURALIS PLASTIC SURGERY & WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 E LANCASTER AVE STE 100
RADNOR PA
19087-5000
US

IV. Provider business mailing address

528 E LANCASTER AVE STE 100
RADNOR PA
19087-5000
US

V. Phone/Fax

Practice location:
  • Phone: 610-477-8244
  • Fax: 610-646-1220
Mailing address:
  • Phone: 610-477-8244
  • Fax: 610-646-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOHN GREGORY FERNANDEZ
Title or Position: OWNER/PHYSICIAN
Credential:
Phone: 215-537-7400