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General NPI Number Information
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NPI Number | 1346226644
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Entity Type | Individual
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Provider Name | CARLOS FERNANDEZ-MAYMI M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 305 MEMORIAL MEDICAL PKWY STE 405
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5169
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Country | US
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Telephone | 989-584-3981
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Fax |
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Provider Business Mailing Address
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Address Line | 305 MEMORIAL MEDICAL PKWY STE 405
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5169
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Country | US
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Telephone |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 6839
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License Number State | PR
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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 | 4301067245
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME145523
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License Number State | FL
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