MEDICARE: ELIZA FERNANDEZ FIRST ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	24-342	FL

General Provider Information

NPI Number	:	1447094537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZA FERNANDEZ FIRST ASSISTANT

Provider Business Mailing Address
First Line	:	6580 GRANT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-5840
Country	:	US
Telephone Number	:	305-992-2593
Fax Number	:

Provider Business Practice Location Address
First Line	:	6580 GRANT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-5840
Country	:	US
Telephone Number	:	305-992-2593
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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