Provider Information for 1144579129
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Mr. GIL J FERNANDEZ Ms
Sex: Male
NPI: 1144579129
Last Updated: 2019-09-03
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1144579129 | ||||||||
| Enumeration Date | 2012-09-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4216 S MANHATTAN AVE APT 207 TAMPA, FL 33611-1342 United States Phone: 786-315-1512 | Fax: | ||||||||
| Primary Practice Address | 6610 E FOWLER AVE STE K TEMPLE TERRACE, FL 33617-2443 United States Phone: 813-553-9150 | Fax: | ||||||||
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