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NPI Code Detail

MEDICARE: ELOISA REBECCA FERNANDEZ MSW

MEDICARE:   ELOISA REBECCA FERNANDEZ  MSW
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1497090328
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELOISA REBECCA FERNANDEZ MSW
Provider Business Mailing Address
First Line : 9845 SW 212TH ST
Second Line :
City : CUTLER BAY
State : FL
Zip : 33189-3104
Country : US
Telephone Number : 305-772-0458
Fax Number :
Provider Business Practice Location Address
First Line : 9845 SW 212TH ST
Second Line :
City : CUTLER BAY
State : FL
Zip : 33189-3104
Country : US
Telephone Number : 305-772-0458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2012
Last Update Date : 12/04/2012

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