Healthcare Provider Details

I. General information

NPI: 1811083116
Provider Name (Legal Business Name): LAURA FERNANDES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MEDICAL PLAZA DR SUITE 520
SHENANDOAH TX
77380-3260
US

IV. Provider business mailing address

920 MEDICAL PLAZA DR SUITE 520
SHENANDOAH TX
77380-3260
US

V. Phone/Fax

Practice location:
  • Phone: 832-562-3974
  • Fax: 832-813-0233
Mailing address:
  • Phone: 832-562-3974
  • Fax: 832-813-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberK7017
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberK7017
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: