Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | D7034 | TX |
N | 2084N0402X | Child Neurologist | D7034 | TX |
NPI | 1053492090 |
---|---|
Provider Name | Fabio Fernandez |
First Address | Houston, TX 77030-2316 |
Second Address | Houston, TX 77030-2316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 07/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136185905 | (05) | TX |
B87789 | (02) |