# MARTA R FERNANDEZ MD P A

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780880203
- **Authorized official:** DR. MARTA R FERNANDEZ MD PA (PRESIDENT)
- **Authorized official phone:** (305) 608-0524

## Contact information

- **Practice address:** 2500 DEL PRADO BLVD S, CAPE CORAL, FL 33904-5750
- **Practice address phone:** (239) 772-1194
- **Practice address fax:** (239) 772-1196
- **Mailing address:** 2500 DEL PRADO BLVD S, CAPE CORAL, FL 33904-5750
- **Mailing address phone:** (239) 772-1194
- **Mailing address fax:** (239) 772-1196

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME90692 | FL | Yes |

## Other

- **Enumeration date:** 06/22/2007
- **Last updated:** 10/12/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 268370900 | MEDICAID PROVIDER | FL |
| 01 | — | ME90692 | MEDICAL LICENSE | FL |