Provider Demographics
NPI:1528040086
Name:FERNANDEZ, ENRIQUE C (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:C
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:PO BOX 55 8642
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-0218
Mailing Address - Country:US
Mailing Address - Phone:305-559-9732
Mailing Address - Fax:305-559-9277
Practice Address - Street 1:11760 BIRD RD
Practice Address - Street 2:SUITE 502
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:305-559-9732
Practice Address - Fax:305-559-9277
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H74736Medicare UPIN
FL71198ZMedicare PIN