Provider Demographics
NPI:1437492576
Name:DONOSO, FERNANDO XAVIER (DO)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:XAVIER
Last Name:DONOSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SIMMONS LOOP FL 4
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-9498
Mailing Address - Country:US
Mailing Address - Phone:813-302-8388
Mailing Address - Fax:813-302-8453
Practice Address - Street 1:6901 SIMMONS LOOP
Practice Address - Street 2:4TH FLOOR
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-9498
Practice Address - Country:US
Practice Address - Phone:813-302-8388
Practice Address - Fax:813-302-8453
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13659207R00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018042300Medicaid
FLP01713931OtherRAILROAD MEDICARE PROVIDER NUMBER
FL018042300Medicaid