Provider Demographics
NPI:1093597940
Name:FERNANDEZ, ROXANA J
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:J
Last Name: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 1:13021 SW 242ND ST APT 314
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4119
Mailing Address - Country:US
Mailing Address - Phone:786-303-7728
Mailing Address - Fax:
Practice Address - Street 1:13021 SW 242ND ST APT 314
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4119
Practice Address - Country:US
Practice Address - Phone:786-303-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty