Provider Demographics
NPI:1205469640
Name:FERNANDEZ, JORGE (CBHCMS,CBHCM)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:CBHCMS,CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15115 SW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4904
Mailing Address - Country:US
Mailing Address - Phone:305-812-4807
Mailing Address - Fax:
Practice Address - Street 1:15115 SW 31ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4904
Practice Address - Country:US
Practice Address - Phone:305-812-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty