Provider Demographics
NPI:1417720160
Name:FERNANDEZ SOLANO, MARIA CONSUELO
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CONSUELO
Last Name:FERNANDEZ SOLANO
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 1:818 E MOWRY DR APT 909
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-8138
Mailing Address - Country:US
Mailing Address - Phone:786-735-7355
Mailing Address - Fax:
Practice Address - Street 1:9370 SW 72ND ST STE A200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5452
Practice Address - Country:US
Practice Address - Phone:786-488-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty