Provider Demographics
NPI:1255834701
Name:FERNANDEZ, ODALYS
Entity Type:Individual
Prefix:MS
First Name:ODALYS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8785 SW 165TH AVE STE 106D
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5827
Mailing Address - Country:US
Mailing Address - Phone:786-391-2935
Mailing Address - Fax:786-409-2019
Practice Address - Street 1:8785 SW 165TH AVE STE 106D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5827
Practice Address - Country:US
Practice Address - Phone:786-391-2935
Practice Address - Fax:786-409-2019
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician