MEDICARE: JARED FERNANDEZ ACSW, PPSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		CA

General Provider Information

NPI Number	:	1356205611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED FERNANDEZ ACSW, PPSC

Provider Business Mailing Address
First Line	:	21 CALLE ESPOLON
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-2302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27800 MEDICAL CENTER RD
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6410
Country	:	US
Telephone Number	:	949-866-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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