MEDICARE: VICTORIA CANDELA FERNANDEZ LAC

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	171100000X	Acupuncturist	AP4180	FL

General Provider Information

NPI Number	:	1720680044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CANDELA FERNANDEZ LAC

Provider Business Mailing Address
First Line	:	3250 SW 20TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2254
Country	:	US
Telephone Number	:	305-903-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3399 NW 72ND AVE STE 224
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33122-1344
Country	:	US
Telephone Number	:	305-298-8489
Fax Number	:

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

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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Directions to “ VICTORIA CANDELA FERNANDEZ LAC” Practice Location

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