Provider Demographics
NPI:1790931327
Name:FAGUNDEZ, JENYFFER DENISE (MD)
Entity Type:Individual
Prefix:
First Name:JENYFFER
Middle Name:DENISE
Last Name:FAGUNDEZ
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 1:501 NW 179TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2807
Mailing Address - Country:US
Mailing Address - Phone:954-442-2828
Mailing Address - Fax:954-442-3366
Practice Address - Street 1:501 NW 179TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2807
Practice Address - Country:US
Practice Address - Phone:954-442-2828
Practice Address - Fax:954-442-3366
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine