Provider Demographics
NPI:1164581195
Name:FERNANDO FANDINO SENDE MD PA
Entity Type:Organization
Organization Name:FERNANDO FANDINO SENDE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FANDINO-SENDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-672-4497
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-672-4497
Mailing Address - Fax:305-531-6673
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-672-4497
Practice Address - Fax:305-531-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10901OtherBCBS OF FL
FL375403100Medicaid
FLK8141Medicare PIN
FL10901OtherBCBS OF FL