Provider Demographics
NPI:1740445626
Name:CARMEN C FERNANDEZ MD PA
Entity type:Organization
Organization Name:CARMEN C FERNANDEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-569-0002
Mailing Address - Street 1:PO BOX 830848
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33283-0848
Mailing Address - Country:US
Mailing Address - Phone:305-569-0002
Mailing Address - Fax:305-569-0005
Practice Address - Street 1:6419 SW BIRD ROAD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-569-0002
Practice Address - Fax:305-569-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047928400Medicaid
FLA62332Medicare UPIN