Provider Demographics
NPI:1023690864
Name:GINEBRA SIRI, FERNANDO ALFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ALFREDO
Last Name:GINEBRA SIRI
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 1:295 JOHNSTON AVE APT 429
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-4320
Mailing Address - Country:US
Mailing Address - Phone:929-216-3387
Mailing Address - Fax:
Practice Address - Street 1:596 COURTLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-8902
Practice Address - Country:US
Practice Address - Phone:407-249-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME167521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program