Provider Demographics
NPI:1952388274
Name:FERNANDEZ, LOUIS ADALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:ADALBERTO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 NW 87TH AVENUE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172
Mailing Address - Country:US
Mailing Address - Phone:305-558-3300
Mailing Address - Fax:305-558-5775
Practice Address - Street 1:2301 NW 87TH AVENUE
Practice Address - Street 2:SUITE 502
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172
Practice Address - Country:US
Practice Address - Phone:305-558-3300
Practice Address - Fax:305-558-5775
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53375207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063088800Medicaid
FL07996Medicare PIN
FLE75790Medicare UPIN