Provider Demographics
NPI:1700760220
Name:FERNANDEZ, RICARDO JOSE
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:JOSE
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8748 N MINGO RD APT 1705
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5082
Mailing Address - Country:US
Mailing Address - Phone:321-900-6815
Mailing Address - Fax:
Practice Address - Street 1:8748 N MINGO RD APT 1705
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5082
Practice Address - Country:US
Practice Address - Phone:321-900-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKZ299751689172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver