Provider Demographics
NPI:1083122121
Name:TOVAR FERNANDEZ, TELENIA D
Entity Type:Individual
Prefix:
First Name:TELENIA
Middle Name:D
Last Name:TOVAR FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 NW 97TH AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4156
Mailing Address - Country:US
Mailing Address - Phone:305-951-7888
Mailing Address - Fax:
Practice Address - Street 1:8912 W FLAGLER ST APT 216
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3943
Practice Address - Country:US
Practice Address - Phone:305-951-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator