Healthcare Provider Details

I. General information

NPI: 1063919785
Provider Name (Legal Business Name): XENIA CATALINA FERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 GOVERNOR ST STE 3
PROVIDENCE RI
02906-3237
US

IV. Provider business mailing address

285 GOVERNOR ST STE 3
PROVIDENCE RI
02906-3237
US

V. Phone/Fax

Practice location:
  • Phone: 401-383-4411
  • Fax:
Mailing address:
  • Phone: 401-383-4411
  • Fax: 401-383-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD18102
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: