Provider Demographics
NPI:1457014144
Name:FERNANDEZ, FIDEL (LMT)
Entity Type:Individual
Prefix:
First Name:FIDEL
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 S DIXIE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-3651
Mailing Address - Country:US
Mailing Address - Phone:786-447-6031
Mailing Address - Fax:
Practice Address - Street 1:5801 S DIXIE HWY STE B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-3651
Practice Address - Country:US
Practice Address - Phone:786-447-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80988225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist