Provider Demographics
NPI:1598087520
Name:FERNANDEZ, HERIBERTO (MD)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
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 1:777 E 25TH ST STE 509
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3834
Mailing Address - Country:US
Mailing Address - Phone:305-420-5016
Mailing Address - Fax:786-452-9901
Practice Address - Street 1:777 E 25TH ST STE 509
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3834
Practice Address - Country:US
Practice Address - Phone:305-420-5016
Practice Address - Fax:786-452-9901
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 109800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004351200Medicaid