Provider Demographics
NPI:1275593832
Name:FERNANDEZ, BERNARDO JR (MD)
Entity Type:Individual
Prefix:
First Name:BERNARDO
Middle Name:
Last Name:FERNANDEZ
Suffix:JR
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 1:1500 SAN REMO AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3043
Mailing Address - Country:US
Mailing Address - Phone:786-527-9205
Mailing Address - Fax:786-533-9678
Practice Address - Street 1:1500 SAN REMO AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3043
Practice Address - Country:US
Practice Address - Phone:786-527-9205
Practice Address - Fax:786-533-9678
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059551207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054513900Medicaid
FL11989ZMedicare ID - Type Unspecified
FLE90171Medicare UPIN