Provider Demographics
NPI:1720101900
Name:FERNANDEZ, ROBERTO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:A
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 1:2885SW3RD AVE 300-400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2324
Mailing Address - Country:US
Mailing Address - Phone:786-717-7509
Mailing Address - Fax:786-717-7529
Practice Address - Street 1:2885SW3RD AVE 300-400
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2324
Practice Address - Country:US
Practice Address - Phone:786-717-7509
Practice Address - Fax:786-717-7529
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16642208D00000X
FLACN 259208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN 259OtherMEDICAL LICENSE
PR16642OtherMEDICAL DOCTOR