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General NPI Number Information
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NPI Number | 1306279385
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Entity Type | Individual
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Provider Name | IDANIA A FERNANDEZ D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 1869 NW 20TH ST
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City | MIAMI
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State | FL
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Zip | 33142-7431
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Country | US
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Telephone | 305-549-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 1267 SW 19TH ST
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City | MIAMI
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State | FL
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Zip | 33145-2914
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Country | US
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Telephone | 305-794-3783
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 004790
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License Number State | FL
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