Provider Demographics
NPI:1437989100
Name:FERNANDEZ, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
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 1:9970 MARLIN RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8651
Mailing Address - Country:US
Mailing Address - Phone:786-217-2402
Mailing Address - Fax:
Practice Address - Street 1:8867 SW 132ND ST STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5926
Practice Address - Country:US
Practice Address - Phone:786-217-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 261QX0200X
FL64928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology