Provider Demographics
NPI:1063996494
Name:FERNANDEZ, VIVIAN T (PHD RDN LDN CDE)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:T
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PHD RDN LDN CDE
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:T
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD RD LD CDE BC-ADM
Mailing Address - Street 1:8375 SW 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-2529
Mailing Address - Country:US
Mailing Address - Phone:305-323-7687
Mailing Address - Fax:
Practice Address - Street 1:8375 SW 64TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-2529
Practice Address - Country:US
Practice Address - Phone:305-323-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR10546133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered