Healthcare Provider Details

I. General information

NPI: 1699784959
Provider Name (Legal Business Name): STEPHEN M FERNANDEZ M D INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W DUARTE RD
ARCADIA CA
91007-7601
US

IV. Provider business mailing address

909 MICHELTORENA ST
LOS ANGELES CA
90026-2721
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-4714
  • Fax: 626-445-1701
Mailing address:
  • Phone: 323-899-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN MICHAEL FERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-308-5548