Provider Demographics
NPI:1629455233
Name:NOEL DE JESUS FERNANDEZ MD PA
Entity Type:Organization
Organization Name:NOEL DE JESUS FERNANDEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-443-2691
Mailing Address - Street 1:1975 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3269
Mailing Address - Country:US
Mailing Address - Phone:786-703-1535
Mailing Address - Fax:305-397-2725
Practice Address - Street 1:1975 W 76TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3269
Practice Address - Country:US
Practice Address - Phone:786-703-1535
Practice Address - Fax:305-397-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50044Medicare PIN