Provider Demographics
NPI:1720022635
Name:FERNANDEZ, HECTOR LUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:LUIS
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 1:7150 W 20 AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5509
Mailing Address - Country:US
Mailing Address - Phone:305-822-8229
Mailing Address - Fax:305-826-5805
Practice Address - Street 1:7150 W 20 AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5509
Practice Address - Country:US
Practice Address - Phone:305-822-8229
Practice Address - Fax:305-826-5805
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072428207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255788600Medicaid
FL46221OtherBLUE CROSS BLUE SHIELD
FL46221OtherBLUE CROSS BLUE SHIELD
G94955Medicare UPIN