Provider Demographics
NPI:1306279385
Name:FERNANDEZ, IDANIA A (DO)
Entity type:Individual
Prefix:DR
First Name:IDANIA
Middle Name:A
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2914
Mailing Address - Country:US
Mailing Address - Phone:305-794-3783
Mailing Address - Fax:
Practice Address - Street 1:1869 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7431
Practice Address - Country:US
Practice Address - Phone:305-549-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 004790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist