MEDICARE: ROBERTO A FERNANDEZ DC PA

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	111N00000X	Chiropractor	6686	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2267	OTHER	FL	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2132216	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1891837266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO A FERNANDEZ DC PA

Provider Business Mailing Address
First Line	:	9950 SW 107TH AVE
Second Line	:	SUITE 202
City	:	MIAMI
State	:	FL
Zip	:	33176-2799
Country	:	US
Telephone Number	:	305-270-8800
Fax Number	:	305-270-9110

Provider Business Practice Location Address
First Line	:	9950 SW 107TH AVE
Second Line	:	SUITE 202
City	:	MIAMI
State	:	FL
Zip	:	33176-2799
Country	:	US
Telephone Number	:	305-270-8800
Fax Number	:	305-270-9110

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	ROBERTO A FERNANDEZ
Credential	:	DC
Telephone Number	:	305-270-8800

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	04/10/2013

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