Provider Demographics
NPI:1215067731
Name:FERNANDEZ, RAYMOND PETER (DC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PETER
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4605
Mailing Address - Country:US
Mailing Address - Phone:863-293-3893
Mailing Address - Fax:863-299-1315
Practice Address - Street 1:1619 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4605
Practice Address - Country:US
Practice Address - Phone:863-293-3893
Practice Address - Fax:863-299-1315
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU36855Medicare UPIN