Provider Demographics
NPI:1760432355
Name:FERNANDEZ-ORTIZ, LAURA ISIS (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ISIS
Last Name:FERNANDEZ-ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2310
Mailing Address - Country:US
Mailing Address - Phone:305-757-8040
Mailing Address - Fax:305-757-8011
Practice Address - Street 1:9715 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2310
Practice Address - Country:US
Practice Address - Phone:305-757-8040
Practice Address - Fax:305-757-8011
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
205780617OtherGREAT WEST
FL305423OtherAVMED
205780617OtherTRICARE
205780617OtherVISTA
3434187OtherCIGNA
9344211OtherPHCS
38940OtherNHP
205780617OtherBEECH STREET
205780617OtherFIRST HEALTH
46690OtherBCBS
000170492OtherHUMANA
2625476OtherAETNA
205780617OtherMAJOR LEAGUE BASEBALL
10716OtherDIMENSION
219688703OtherUNITED
P3202324OtherOXFORD