Basic Information
| Provider Information | |||||||||
| NPI: | 1720022635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7150 W 20 AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058228229 | ||||||||
| FaxNumber: | 3058265805 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 W 20 AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058228229 | ||||||||
| FaxNumber: | 3058265805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME0072428 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 255788600 | 05 | FL | MEDICAID | 46221 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |