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General NPI Number Information
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NPI Number | 1073197794
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Entity Type | Individual
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Provider Name | RAFAEL RAMON FERNANDEZ MD, APRN
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Gender | Male
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Dates
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Enumeration Date | 05/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 4834 NW 110TH PL
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City | DORAL
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State | FL
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Zip | 33178-4310
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Country | US
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Telephone | 786-326-4240
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Fax |
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Provider Business Mailing Address
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Address Line | 4834 NW 110TH PL
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City | DORAL
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State | FL
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Zip | 33178-4310
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Country | US
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Telephone | 786-326-4240
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NJDCATEMP041658
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | HSE24274
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CV2102936
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11012992
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11012992
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License Number State | FL
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