MEDICARE: LESLIE FERNANDEZ

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	261QU0200X	Urgent Care Clinic/Center	AP130648	TX
2	363L00000X	Nurse Practitioner	AP130648	TX
3	363LF0000X	Family Nurse Practitioner	AP130648	TX

General Provider Information

NPI Number	:	1558713966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE FERNANDEZ

Provider Business Mailing Address
First Line	:	7929 N SHEPHERD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-6346
Country	:	US
Telephone Number	:	832-640-2640
Fax Number	:

Provider Business Practice Location Address
First Line	:	7929 N SHEPHERD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-6346
Country	:	US
Telephone Number	:	832-640-2640
Fax Number	:

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

Provider Enumeration Date	:	07/09/2016
Last Update Date	:	01/26/2017

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Directions to “ LESLIE FERNANDEZ ” Practice Location

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