MEDICARE: ROSIE FERNANDEZ RN

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	163W00000X	Registered Nurse	497201	CA

General Provider Information

NPI Number	:	1851567408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSIE FERNANDEZ RN

Provider Business Mailing Address
First Line	:	1745 S IMPERIAL AVE
Second Line	:	SUITE 112
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4243
Country	:	US
Telephone Number	:	760-312-9817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 S IMPERIAL AVE
Second Line	:	SUITE 112
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4243
Country	:	US
Telephone Number	:	760-312-9817
Fax Number	:

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

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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