Provider Demographics
NPI:1881764645
Name:FERNANDEZ, YAJAIRA ROSEMARY (OD)
Entity type:Individual
Prefix:DR
First Name:YAJAIRA
Middle Name:ROSEMARY
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 WATERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1438
Mailing Address - Country:US
Mailing Address - Phone:646-373-4401
Mailing Address - Fax:
Practice Address - Street 1:250 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4575
Practice Address - Country:US
Practice Address - Phone:929-297-0483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006823152W00000X
NYTUV006823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006823OtherLICENSE
NY02611329Medicaid
11728195OtherCAQH