Provider Demographics
NPI:1033811781
Name:SMITH, FERNANDO M
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MISSISSIPPI AVE SE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2416
Mailing Address - Country:US
Mailing Address - Phone:202-855-4666
Mailing Address - Fax:
Practice Address - Street 1:227 MISSISSIPPI AVE SE APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2416
Practice Address - Country:US
Practice Address - Phone:202-855-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician