Provider Demographics
NPI:1386462232
Name:FERNANDEZ, JESUS RAMON
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:RAMON
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 1:10391 NW 36TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-1054
Mailing Address - Country:US
Mailing Address - Phone:786-794-1020
Mailing Address - Fax:
Practice Address - Street 1:10391 NW 36TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-1054
Practice Address - Country:US
Practice Address - Phone:786-794-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician