Provider Demographics
NPI:1255540076
Name:FERNANDEZ, NESTOR (MD)
Entity type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:
Last Name:FERNANDEZ
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 1:5801 NW 151ST ST STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2476
Mailing Address - Country:US
Mailing Address - Phone:305-824-4698
Mailing Address - Fax:954-533-9758
Practice Address - Street 1:5801 NW 151ST ST STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2476
Practice Address - Country:US
Practice Address - Phone:305-824-4698
Practice Address - Fax:954-533-9758
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56218207R00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11774Medicare ID - Type Unspecified
FLE74933Medicare UPIN