Provider Demographics
NPI:1174630479
Name:FERNANDEZ-BOMBINO, JULIO A (MD)
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:A
Last Name:FERNANDEZ-BOMBINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W 20 AVENUE
Mailing Address - Street 2:#602
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-557-8300
Mailing Address - Fax:305-557-1410
Practice Address - Street 1:7100 W 20 AVENUE
Practice Address - Street 2:#602
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-557-8300
Practice Address - Fax:305-557-1410
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 43316207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062013100Medicaid
FL062013100Medicaid
FL96969Medicare PIN