Provider Demographics
NPI:1477269884
Name:FERNANDEZ, INGRID MARIA
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:MARIA
Last Name:FERNANDEZ
Suffix:
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 1:1535 SW 122ND AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2837
Mailing Address - Country:US
Mailing Address - Phone:305-922-5223
Mailing Address - Fax:
Practice Address - Street 1:1535 SW 122ND AVE APT 6
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2837
Practice Address - Country:US
Practice Address - Phone:305-922-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician