Provider Demographics
NPI:1356436786
Name:FERNANDEZ-MIRO, HUMBERTO (MD)
Entity type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:
Last Name:FERNANDEZ-MIRO
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 1:7460 SW 64TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-2802
Mailing Address - Country:US
Mailing Address - Phone:305-443-0540
Mailing Address - Fax:305-443-0620
Practice Address - Street 1:7460 SW 64TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-2802
Practice Address - Country:US
Practice Address - Phone:305-691-7515
Practice Address - Fax:305-666-6211
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378210700Medicaid
FL5190726OtherCIGNA
FL378210700Medicaid