Provider Demographics
NPI:1235846411
Name:FERNANDEZ, ARMAND
Entity Type:Individual
Prefix:
First Name:ARMAND
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17655 SW 182ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1600
Mailing Address - Country:US
Mailing Address - Phone:786-252-8833
Mailing Address - Fax:
Practice Address - Street 1:93911 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-3025
Practice Address - Country:US
Practice Address - Phone:786-387-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF655-000-97-287-0OtherLICENSE