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General NPI Number Information
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NPI Number | 1740988401
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Entity Type | Individual
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Provider Name | BISMALIA IVON FERNANDEZ THEN SA-C
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Gender | Female
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 3405 KOSSUTH AVE APT F
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City | BRONX
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State | NY
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Zip | 10467-2444
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Country | US
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Telephone | 551-482-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 3405 KOSSUTH AVE APT F
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City | BRONX
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State | NY
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Zip | 10467-2444
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Country | US
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Telephone | 551-482-7078
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 18-121
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 001285-P.A.
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License Number State | PR
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