Provider Demographics
NPI:1235924242
Name:FERNANDEZ, VICTOR
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 WASHINGTON AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-4349
Mailing Address - Country:US
Mailing Address - Phone:917-332-6874
Mailing Address - Fax:
Practice Address - Street 1:1969 WASHINGTON AVE APT 6A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4349
Practice Address - Country:US
Practice Address - Phone:917-332-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty