Provider Demographics
NPI:1235652207
Name:FERNANDEZ, MARIA PAULA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PAULA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:PAULA
Other - Last Name:FERNANDEZ JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2454 E DEMPSTER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5320
Mailing Address - Country:US
Mailing Address - Phone:847-299-0700
Mailing Address - Fax:847-390-0616
Practice Address - Street 1:2454 E DEMPSTER ST STE 400
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5320
Practice Address - Country:US
Practice Address - Phone:847-299-0700
Practice Address - Fax:847-390-0616
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME149505207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program