Provider Demographics
NPI:1225071780
Name:FERNANDEZ, BEATRIZ B (OTD/ OTR/L)
Entity Type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:B
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OTD/ OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 TAFT STREET
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026
Mailing Address - Country:US
Mailing Address - Phone:954-641-9507
Mailing Address - Fax:954-367-1603
Practice Address - Street 1:12105 TAFT STREET
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026
Practice Address - Country:US
Practice Address - Phone:954-641-9507
Practice Address - Fax:954-367-1603
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890442100Medicaid
FL890442100Medicaid