Provider Demographics
NPI:1265402051
Name:FERNANDEZ, MANUEL FRANCISCO (MEDICAL DOCTOR)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:FRANCISCO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 W FLAGLER ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2045
Mailing Address - Country:US
Mailing Address - Phone:305-207-1818
Mailing Address - Fax:305-207-1820
Practice Address - Street 1:295 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-8010
Practice Address - Country:US
Practice Address - Phone:855-226-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066369208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373393900Medicaid
FLF78204Medicare UPIN
FL373393900Medicaid