Provider Demographics
NPI:1841499894
Name:FERNANDEZ, MARITZA PAZ (DC, CAD)
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:PAZ
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DC, CAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 NE 26TH TER
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2718
Mailing Address - Country:US
Mailing Address - Phone:954-483-5351
Mailing Address - Fax:
Practice Address - Street 1:3471 N FEDERAL HWY
Practice Address - Street 2:SUITE 402
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1019
Practice Address - Country:US
Practice Address - Phone:954-417-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22853 AOtherMEDICARE PTAN
FL22853OtherBCBS
FL380833500Medicaid
FL380833500Medicaid