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NPI Code Detail

MEDICARE: STEFANIE FERNANDEZ

MEDICARE: STEFANIE 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
1167G00000XLicensed Psychiatric Technician30302CA

General Provider Information

NPI Number : 1629409800
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEFANIE FERNANDEZ
Provider Business Mailing Address
First Line : 229 SAN LUIS PARKWAY
Second Line :
City : AVILA BEACH
State : CA
Zip : 93424
Country : US
Telephone Number : 805-748-8069
Fax Number :
Provider Business Practice Location Address
First Line : 2945 MCMILLAN AVE STE 240
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-6771
Country : US
Telephone Number : 805-439-4839
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2013
Last Update Date : 05/22/2019

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Directions to “ STEFANIE FERNANDEZ ” Practice Location

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