Provider Demographics
NPI:1467075119
Name:FERNANDEZ, OLGA I
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:FERNANDEZ
Suffix:I
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 1:3471 NW 182ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-3443
Mailing Address - Country:US
Mailing Address - Phone:786-872-1643
Mailing Address - Fax:
Practice Address - Street 1:3471 NW 182ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-3443
Practice Address - Country:US
Practice Address - Phone:786-872-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician