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General NPI Number Information
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NPI Number | 1932504941
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Entity Type | Organization
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Legal Business Name | FERNANDEZ-GONZALEZ M.D.;P.A.
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 4790 NW 7TH ST STE 212
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City | MIAMI
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State | FL
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Zip | 33126-2200
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Country | US
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Telephone | 305-639-8109
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Fax | 305-639-8302
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Provider Business Mailing Address
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Address Line | 4790 NW 7TH ST STE 212
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City | MIAMI
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State | FL
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Zip | 33126-2200
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Country | US
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Telephone | 305-639-8109
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Fax | 305-639-8302
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANUEL FERNANDEZ-GONZALEZ
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Credential | M.D.
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Telephone | 305-639-8109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME17907
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License Number State | FL
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