Individual
LIDETTE REBECCA FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6447 MIAMI LAKES DR, SUITE 105, MIAMI LAKES, FL 33014-2741
(786) 365-4834
Mailing address
7474 NW 167TH TER, HIALEAH, FL 33015-4151
(305) 965-5465
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
3958
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
889913400
—
FL
Enumeration date
02/21/2007
Last updated
10/17/2016
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