Provider Demographics
NPI:1326556127
Name:FERNANDEZ, GEORGE LUIS (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LUIS
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16401 NW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6313
Mailing Address - Country:US
Mailing Address - Phone:305-628-6533
Mailing Address - Fax:
Practice Address - Street 1:16401 NW 37TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-6313
Practice Address - Country:US
Practice Address - Phone:305-628-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL31122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer