Provider Demographics
NPI:1942497110
Name:FERNANDEZ, DANIEL (LMT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 S MCCALL RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4864
Mailing Address - Country:US
Mailing Address - Phone:941-474-5050
Mailing Address - Fax:
Practice Address - Street 1:1460 S MCCALL RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4864
Practice Address - Country:US
Practice Address - Phone:941-474-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist