Provider Demographics
NPI:1144051459
Name:FERNANDEZ, GERALYN (RT(R)(MR))
Entity type:Individual
Prefix:MRS
First Name:GERALYN
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RT(R)(MR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9276 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-3033
Mailing Address - Country:US
Mailing Address - Phone:610-301-7960
Mailing Address - Fax:
Practice Address - Street 1:9276 101ST AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-3033
Practice Address - Country:US
Practice Address - Phone:610-301-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT988232471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging