=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467769497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WE CARE MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2010
-----------------------------------------------------
Last Update Date | 09/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4005 NW 114TH AVE SUITE 26
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33178-4374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-994-9449
-----------------------------------------------------
Fax | 305-994-9477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4005 NW 114TH AVE SUITE 26
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33178-4374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-994-9449
-----------------------------------------------------
Fax | 305-994-9477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MANUEL A FERNANDEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-994-9449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME17907
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------