Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO3686 | FL |
NPI | 1053678052 |
---|---|
Provider Name | Dr. Alexander Fernando San Diego JR. |
First Address | Merritt Island, FL 32953-4191 |
Second Address | Merritt Island, FL 32953-4191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 24/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053678052 | NPI (01) | |
13574563 | CAQH (01) |