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General NPI Number Information
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NPI Number | 1427174747
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Entity Type | Organization
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Legal Business Name | LINO B FERNANDEZ MD PA
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 717 PONCE DE LEON BLVD SUITE 202
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City | CORAL GABLES
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State | FL
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Zip | 33134-2060
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Country | US
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Telephone | 305-444-3532
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Fax | 305-442-1104
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Provider Business Mailing Address
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Address Line | 717 PONCE DE LEON BLVD SUITE 202
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City | CORAL GABLES
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State | FL
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Zip | 33134-2060
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Country | US
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Telephone | 305-444-3532
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Fax | 305-442-1104
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINO BERNABE FERNANDEZ SR.
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Credential | M.D.
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Telephone | 305-444-3532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME39453
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME39453
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License Number State | FL
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