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General NPI Number Information
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NPI Number | 1508152968
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Entity Type | Organization
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Legal Business Name | ROBERTO J FERNANDEZ MD PA
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 135 W 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-3711
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Country | US
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Telephone | 305-822-1590
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Fax | 305-826-3177
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Provider Business Mailing Address
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Address Line | PO BOX 127008
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City | HIALEAH
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State | FL
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Zip | 33012-1617
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Country | US
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Telephone | 305-822-1590
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Fax | 305-826-3177
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERTO FERNANDEZ
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Credential | MD
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Telephone | 305-822-1590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME43363
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License Number State | FL
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