=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164581195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FERNANDO FANDINO SENDE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 01/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4302 ALTON RD SUITE 1000
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-2891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-672-4497
-----------------------------------------------------
Fax | 305-531-6673
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4302 ALTON RD SUITE 1000
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-2891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-672-4497
-----------------------------------------------------
Fax | 305-531-6673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. FERNANDO FANDINO-SENDE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-672-4497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME51899
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------