=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558618132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALIUSKA GARCIA FERNANDEZ DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2012
-----------------------------------------------------
Last Update Date | 11/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6500 COW PEN RD STE 201
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-7620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-226-7461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6500 COW PEN RD STE 201
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-7620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-226-7461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN20967
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------