Provider Demographics
NPI:1780666750
Name:FERNANDEZ, MARTA ROSA (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:ROSA
Last Name:FERNANDEZ
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 1:7900 NW 33RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2209
Mailing Address - Country:US
Mailing Address - Phone:954-962-5300
Mailing Address - Fax:954-962-0100
Practice Address - Street 1:7900 NW 33RD ST STE 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2209
Practice Address - Country:US
Practice Address - Phone:954-962-5300
Practice Address - Fax:954-962-0100
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90692208D00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2106Medicare PIN
FLU2106NMedicare PIN
FLU2106TMedicare PIN
FLI-02011Medicare UPIN