Provider Demographics
NPI:1841984549
Name:FERNANDEZ, IVAN FRANCISCO (CBHCM)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:FRANCISCO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 SCOTT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2400
Mailing Address - Country:US
Mailing Address - Phone:786-710-6905
Mailing Address - Fax:
Practice Address - Street 1:9900 STIRLING RD STE 103
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8073
Practice Address - Country:US
Practice Address - Phone:954-300-2921
Practice Address - Fax:954-901-2815
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management