Provider Demographics
NPI:1215940747
Name:FERNANDEZ TAMAYO, MARIA E (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:E
Last Name:FERNANDEZ TAMAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13500 SW 88TH ST STE 175
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1528
Mailing Address - Country:US
Mailing Address - Phone:305-387-0081
Mailing Address - Fax:305-387-0053
Practice Address - Street 1:ULTIMATE MEDICAL CENTER & SPA. LLC.
Practice Address - Street 2:12700 SW 128TH STREET, SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5378
Practice Address - Country:US
Practice Address - Phone:305-278-7579
Practice Address - Fax:305-278-7589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME137016208D00000X, 208D00000X, 207VG0400X
PR9372207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083354OtherPTAN
PR9372OtherMEDICAL LICENCE
FLME137016OtherMEDICAL LICENSE