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NPI Code Detail

MEDICARE: MARLENE FERNANDEZ

MEDICARE:   MARLENE  FERNANDEZ
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
1103TS0200XSchool PsychologistSS1063FL

General Provider Information

NPI Number : 1710365309
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARLENE FERNANDEZ
Provider Business Mailing Address
First Line : 1055 GROVE PARK CIR
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33436-9437
Country : US
Telephone Number : 561-801-0803
Fax Number :
Provider Business Practice Location Address
First Line : 1055 GROVE PARK CIR
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33436-9437
Country : US
Telephone Number : 561-801-0803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2015
Last Update Date : 05/14/2015

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Directions to “ MARLENE FERNANDEZ ” Practice Location

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