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General NPI Number Information
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NPI Number | 1649557059
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Entity Type | Individual
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Provider Name | JORGE ENRIQUE FERNANDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 11420 N KENDALL DR STE 110
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City | MIAMI
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State | FL
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Zip | 33176-1039
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Country | US
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Telephone | 786-353-2536
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Fax |
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Provider Business Mailing Address
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Address Line | 16325 NW 78TH AVE
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City | MIAMI LAKES
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State | FL
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Zip | 33016-8410
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Country | US
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Telephone | 786-218-0068
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN - 752
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME163130
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 020989
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License Number State | PR
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