Provider Demographics
NPI:1588155964
Name:FERNANDEZ, ANIURYS
Entity type:Individual
Prefix:
First Name:ANIURYS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13335 SW 118TH PASS
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5245
Mailing Address - Country:US
Mailing Address - Phone:305-333-2780
Mailing Address - Fax:
Practice Address - Street 1:7575 W FLAGLER ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2467
Practice Address - Country:US
Practice Address - Phone:305-377-3297
Practice Address - Fax:305-377-3854
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCCM100295171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator