Provider Demographics
NPI:1013186337
Name:FERNANDEZ, ROBERTO ANGEL (DC)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:ANGEL
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 SW 107TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2785
Mailing Address - Country:US
Mailing Address - Phone:305-270-8800
Mailing Address - Fax:305-270-9110
Practice Address - Street 1:9950 SW 107TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2785
Practice Address - Country:US
Practice Address - Phone:305-270-8800
Practice Address - Fax:305-270-9110
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380400300Medicaid
FL380400300Medicaid