Provider Demographics
NPI:1780418897
Name:FERNANDEZ, CARLOS ESTEBAN
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ESTEBAN
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 SE 7TH AVE APT C
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9619
Mailing Address - Country:US
Mailing Address - Phone:352-426-9029
Mailing Address - Fax:
Practice Address - Street 1:2820 SE 7TH AVE APT C
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9619
Practice Address - Country:US
Practice Address - Phone:352-426-9029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99747225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist