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General NPI Number Information
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NPI Number | 1932383460
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Entity Type | Organization
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Legal Business Name | ENRIQUE C FERNANDEZ MD PA
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 11760 BIRD RD SUITE 741
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City | MIAMI
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State | FL
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Zip | 33175-3582
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Country | US
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Telephone | 305-559-9732
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Fax | 786-427-1332
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Provider Business Mailing Address
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Address Line | PO BOX 558642
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City | MIAMI
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State | FL
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Zip | 33255-8642
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Country | US
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Telephone | 305-559-9732
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Fax | 786-427-1332
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ENRIQUE C FERNANDEZ
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Credential | MD
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Telephone | 305-559-9732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME87802
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License Number State | FL
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