Provider Demographics
NPI:1457319881
Name:FERNANDEZ, CARMEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:C
Last Name:FERNANDEZ
Suffix:
Gender:F
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 830848
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33283-0848
Mailing Address - Country:US
Mailing Address - Phone:305-569-0002
Mailing Address - Fax:
Practice Address - Street 1:5000 UNIVERSITY DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2008
Practice Address - Country:US
Practice Address - Phone:305-569-0002
Practice Address - Fax:305-569-0005
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 43067173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047928400Medicaid
FLP00120067OtherRAILROAD MEDICARE
FL96497OtherBLUE CROSS BLUE SHIELD
FL650237193OtherTAX ID
FL96497OtherBLUE CROSS BLUE SHIELD
FL96497Medicare ID - Type UnspecifiedMEDICARE