Provider Demographics
NPI:1073533527
Name:JACOBS-FERNANDEZ, CATALINA ROSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CATALINA
Middle Name:ROSA
Last Name:JACOBS-FERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAJORCA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4508
Mailing Address - Country:US
Mailing Address - Phone:305-807-0473
Mailing Address - Fax:305-851-0253
Practice Address - Street 1:101 MAJORCA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4508
Practice Address - Country:US
Practice Address - Phone:305-807-2773
Practice Address - Fax:305-851-0253
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54561AOtherBLUE CROSS BLUE SHIELD
S15433Medicare UPIN
FLZ3468Medicare ID - Type Unspecified