Provider Demographics
NPI:1073294146
Name:FERNANDEZ MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:FERNANDEZ MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOSA VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-202-4655
Mailing Address - Street 1:7600 W 20TH AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1894
Mailing Address - Country:US
Mailing Address - Phone:305-202-4655
Mailing Address - Fax:
Practice Address - Street 1:7600 W 20TH AVE STE 224
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1894
Practice Address - Country:US
Practice Address - Phone:305-202-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy