Healthcare Provider Details

I. General information

NPI: 1982148037
Provider Name (Legal Business Name): AIDA CRISTINA FERNANDEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 N 24TH ST
PHOENIX AZ
85008-1004
US

IV. Provider business mailing address

2850 N 24TH ST
PHOENIX AZ
85008-1004
US

V. Phone/Fax

Practice location:
  • Phone: 602-200-0434
  • Fax: 602-200-0445
Mailing address:
  • Phone: 602-200-0434
  • Fax: 602-200-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4750
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: