Provider Demographics
NPI:1093730913
Name:FERNANDEZ-GARCIA, ALICIA E (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:E
Last Name:FERNANDEZ-GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 LASALLE LEFALL DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-5278
Mailing Address - Country:US
Mailing Address - Phone:850-875-3600
Mailing Address - Fax:850-627-7277
Practice Address - Street 1:178 LASALLE LEFALL DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-5278
Practice Address - Country:US
Practice Address - Phone:850-875-3600
Practice Address - Fax:850-627-7277
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053193208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10169OtherBLUE CROSS
FL061806300Medicaid
FL061806300Medicaid