Provider Demographics
NPI:1922208891
Name:FERNANDEZ, ADELA M (MD)
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:M
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 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:800-642-2398
Practice Address - Street 1:350 NW 84TH AVE STE 200B
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1817
Practice Address - Country:US
Practice Address - Phone:954-577-2294
Practice Address - Fax:954-577-2297
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121151208D00000X
FLME 121151208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice