Provider Demographics
NPI:1962791244
Name:FERNANDEZ, MIGDALYS I (LMT)
Entity type:Individual
Prefix:MRS
First Name:MIGDALYS
Middle Name:
Last Name:FERNANDEZ
Suffix:I
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MIGDALYS
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:12732 SW 17TH TER
Mailing Address - Street 2:12732 SW 17 TERR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1223
Mailing Address - Country:US
Mailing Address - Phone:786-426-7071
Mailing Address - Fax:
Practice Address - Street 1:12732 AVE SWE 17 TERRA
Practice Address - Street 2:12732
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:786-426-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62399111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62399OtherMASSAGE THERAPIST