Provider Demographics
NPI:1437535663
Name:FERNANDEZ, OLGA (REGISTERED DIETICIAN)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:REGISTERED DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5738
Mailing Address - Country:US
Mailing Address - Phone:772-223-0953
Mailing Address - Fax:
Practice Address - Street 1:2854 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5738
Practice Address - Country:US
Practice Address - Phone:772-223-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 2397133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered