Provider Demographics
NPI:1710640594
Name:FERNANDEZ, JOAQUIN EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:EDUARDO
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 1:10315 NW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2657
Mailing Address - Country:US
Mailing Address - Phone:786-338-5650
Mailing Address - Fax:
Practice Address - Street 1:10315 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2657
Practice Address - Country:US
Practice Address - Phone:786-338-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ041902207Q00000X
INCV2102937207Q00000X
NHEL07953207Q00000X
FLHSE18306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine