Provider Demographics
NPI:1881682342
Name:FERNANDEZ, LINO B (MD)
Entity Type:Individual
Prefix:
First Name:LINO
Middle Name:B
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 1:2103 CORAL WAY STE 601
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2656
Mailing Address - Country:US
Mailing Address - Phone:305-967-8144
Mailing Address - Fax:888-845-0592
Practice Address - Street 1:2103 CORAL WAY STE 601
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2656
Practice Address - Country:US
Practice Address - Phone:305-967-8144
Practice Address - Fax:888-845-0592
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME394532084P0804X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008279700Medicaid
FLD63647Medicare UPIN
FL95888UMedicare PIN
FLGY377ZMedicare PIN