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General NPI Number Information
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NPI Number | 1164441713
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Entity Type | Organization
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Legal Business Name | JUAN A FERNANDEZ MD PA
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 5040 NW 7TH ST SUITE 370
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City | MIAMI
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State | FL
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Zip | 33126-3422
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Country | US
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Telephone | 305-648-1087
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Fax | 305-648-1088
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Provider Business Mailing Address
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Address Line | PO BOX 142201
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City | CORAL GABLES
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State | FL
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Zip | 33114-2201
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Country | US
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Telephone | 305-648-1087
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Fax | 305-648-1088
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN A FERNANDEZ
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Credential | MD
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Telephone | 305-648-1087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME68513
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME68513
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License Number State | FL
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