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General NPI Number Information
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NPI Number | 1023690864
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Entity Type | Individual
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Provider Name | FERNANDO ALFREDO GINEBRA SIRI MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 07/21/2024
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Provider Practice Location Address
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Address Line | 596 COURTLAND BLVD
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City | DELTONA
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State | FL
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Zip | 32738-8902
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Country | US
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Telephone | 407-249-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 295 JOHNSTON AVE APT 429
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City | JERSEY CITY
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State | NJ
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Zip | 07304-4320
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Country | US
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Telephone | 929-216-3387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME167521
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License Number State | FL
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