Healthcare Provider Details

I. General information

NPI: 1508202144
Provider Name (Legal Business Name): TASHA JUDITH FERNANDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 09/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W ORANGE AVE
ANAHEIM CA
92804-3156
US

IV. Provider business mailing address

3033 W ORANGE AVE
ANAHEIM CA
92804-3156
US

V. Phone/Fax

Practice location:
  • Phone: 714-817-3000
  • Fax: 818-587-2493
Mailing address:
  • Phone: 714-827-3000
  • Fax: 818-587-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA132861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: