Provider Demographics
NPI:1548255839
Name:FERNANDEZ, OTILIA P (MD)
Entity type:Individual
Prefix:
First Name:OTILIA
Middle Name:P
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:OTILIA
Other - Middle Name:P
Other - Last Name:PERRINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4330 DRAKE RD.
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243
Mailing Address - Country:US
Mailing Address - Phone:513-563-0044
Mailing Address - Fax:513-563-0061
Practice Address - Street 1:11258 LEBANON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2214
Practice Address - Country:US
Practice Address - Phone:513-563-0044
Practice Address - Fax:513-563-0061
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-054804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078183OtherMEDICAID