Provider Demographics
NPI:1710969688
Name:TRESPALACIOS, FERNANDO C (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:C
Last Name:TRESPALACIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9193 SUNSET DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3487
Mailing Address - Country:US
Mailing Address - Phone:305-273-9377
Mailing Address - Fax:305-273-9388
Practice Address - Street 1:9193 SUNSET DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3487
Practice Address - Country:US
Practice Address - Phone:305-273-9377
Practice Address - Fax:305-273-9388
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91609207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051203OtherNHP
FL270979100OtherPSN
FL270979100Medicaid
FL0275248OtherCIGNA
FL296787OtherAVMED
FL270979100OtherSOUTH FLORIDA COMMUNITY CARE NETWORK
FL270979100OtherPSN
FLI21791Medicare UPIN