Provider Demographics
NPI:1417382979
Name:FERNANDEZ, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:FERNANDEZ
Suffix:
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:PO BOX 025323
Mailing Address - Street 2:CCS10138
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33102-5323
Mailing Address - Country:US
Mailing Address - Phone:646-713-4381
Mailing Address - Fax:
Practice Address - Street 1:A1 CAURIMARE
Practice Address - Street 2:POLICLINICA METROPOLITANA 4G
Practice Address - City:CARACAS
Practice Address - State:MIRANDA
Practice Address - Zip Code:1080
Practice Address - Country:VE
Practice Address - Phone:212-985-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1149752086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery