Individual provider Active NPI

Elizabeth Maria Fernandez, M.D.

  • Obstetrics & Gynecology Physician
  • Pembroke Pines, FL
National Provider Identifier
1790866671
Registry record updated Sep 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME60274 Issued in FL
Practice address
601 N Flamingo Rd Ste 305
Pembroke Pines, FL 33028-1010
Phone
(954) 404-8664
Fax
(954) 613-4128
NPI assigned
Oct 18, 2006
Last updated
Sep 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME60274 FL Primary

Addresses

Primary practice location

601 N Flamingo Rd Ste 305
Pembroke Pines, FL 33028-1010

Mailing address

601 N Flamingo Rd Ste 305
Pembroke Pines, FL 33028-1010
Phone (954) 404-8664

Other identifiers 1

IdentifierTypeStateIssuer
102472200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040601000917 FL Practitioner - Obstetrics/Gynecology 4789665167 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME60274FLMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Collazo Fernandez Richards MD's PA Single Specialty PastSince Sep 19, 1997 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1790866671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 N FLAMINGO RD STE 305",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281010",
            "telephone_number": "954-404-8664",
            "fax_number": "954-961-0163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N FLAMINGO RD STE 305",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281010",
            "telephone_number": "954-404-8664",
            "fax_number": "954-613-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "ELIZABETH",
        "middle_name": "MARIA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME60274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102472200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.