Provider Demographics
NPI:1003408444
Name:FERNANDEZ, OLGA J (LMT)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 SW 92ND AVE APT A-316
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5778
Mailing Address - Country:US
Mailing Address - Phone:786-378-3812
Mailing Address - Fax:
Practice Address - Street 1:13100 SW 92ND AVE APT A-316
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5778
Practice Address - Country:US
Practice Address - Phone:786-378-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA81013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist