Provider Demographics
NPI:1073929345
Name:JOSE FERNANDEZ, M.D.P.A.
Entity Type:Organization
Organization Name:JOSE FERNANDEZ, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-251-8016
Mailing Address - Street 1:10700 CARIBBEAN BLVD
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1232
Mailing Address - Country:US
Mailing Address - Phone:305-251-8016
Mailing Address - Fax:305-251-8017
Practice Address - Street 1:10700 CARIBBEAN BLVD
Practice Address - Street 2:SUITE # 108
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1232
Practice Address - Country:US
Practice Address - Phone:305-251-8016
Practice Address - Fax:305-251-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65542208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375244500Medicaid