Provider Demographics
NPI:1083209084
Name:FERNANDEZ MENTAL HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:FERNANDEZ MENTAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-314-0535
Mailing Address - Street 1:11820 MIRAMAR PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5820
Mailing Address - Country:US
Mailing Address - Phone:786-314-0535
Mailing Address - Fax:
Practice Address - Street 1:11820 MIRAMAR PKWY STE 310
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5820
Practice Address - Country:US
Practice Address - Phone:786-314-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management