Osvaldo Antonio Fernandez Dominguez, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME106374 Issued in FL

Practice address

3621 SW 107TH Ave
Miami, FL 33165-3636

Phone

(855) 226-6633

NPI assigned

Feb 20, 2010

Last updated

Jan 9, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Psychiatry

Education

Other, 1985

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Serenity Community Mental Health Center LLCGroup PAC ID 4587946793, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Serenity Community Mental Health Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miami, FL
  • NPI 1457705634
  Medicare reassignment Care Compare group NPD
• Serenity Community Mental Health Center LLC

  • Community/Behavioral Health Agency
  • Pembroke Pines, FL
  • NPI 1497328496
  NPD
• Serenity Community Mental Health Center LLC

  • Community/Behavioral Health Agency
  • Saint Cloud, FL
  • NPI 1952077539
  NPD

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

{
    "created_epoch": "1266624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1821310632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 SW 107TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331653636",
            "telephone_number": "855-226-6633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 SW 107TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331653636",
            "telephone_number": "855-226-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ DOMINGUEZ",
        "first_name": "OSVALDO",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-20",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME106374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002095400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Delio Jesus Fernandez Diaz
• Jorge Luis Fernandez Diaz
• Leticia Fernandez Diaz, MSN, FNP, APRN-C
• Yailin Fernandez Diaz
• Arletis Maria Fernandez Dominguez, DMD
• Rosmeri D Fernandez Dominguez
• Ilsi Fernandez Duarte
• Imandra Fernandez Duarte
• Leyanis Fernandez Duenas
• Kriss Fernandez Duran

• Child & Adolescent Psychiatry Physician in Miami, FL
• Providers in Miami, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.