Provider Demographics
NPI:1104504208
Name:FERNANDEZ, BELISIA OMAYRA (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:BELISIA
Middle Name:OMAYRA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 KARANDA PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5697
Mailing Address - Country:US
Mailing Address - Phone:386-627-5885
Mailing Address - Fax:
Practice Address - Street 1:13 KARANDA PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5697
Practice Address - Country:US
Practice Address - Phone:386-627-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-306397174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN