Provider Demographics
NPI:1518030881
Name:FERNANDEZ, ORLANDO (MD)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 SW 5TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3509
Mailing Address - Country:US
Mailing Address - Phone:305-649-4894
Mailing Address - Fax:305-541-3252
Practice Address - Street 1:1877 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1939
Practice Address - Country:US
Practice Address - Phone:305-649-4894
Practice Address - Fax:305-541-3252
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92362Medicare ID - Type UnspecifiedFL MEDICARE PROV. NUMBER
FLD65979Medicare UPIN