Provider Demographics
NPI:1376045880
Name:FERNANDEZ, OSCAR ANGEL (BA)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:ANGEL
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 W 29TH PL APT 407
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5351
Mailing Address - Country:US
Mailing Address - Phone:786-234-0013
Mailing Address - Fax:
Practice Address - Street 1:490 W 29TH PL APT 407
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5351
Practice Address - Country:US
Practice Address - Phone:786-234-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF655641951290106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAOPY6PJMedicaid